Sanja Stankovic

Publications (9)16.41 Total impact

• Article: Rationale and Design of the On-Treatment PLAtelet Reactivity-Guided Therapy Modification FOR ST-Segment Elevation Myocardial Infarction (PLATFORM) Randomized Trial.

  Igor Mrdovic, Lidija Savic, Gordana Krljanac, Milika Asanin, Natasa Cvetinovic, Natasa Brdar, Milena Stojanovic, Nemanja Djuricic, Sanja Stankovic, Jelena Marinkovic, Jovan Perunicic
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  ABSTRACT: OBJECTIVES: The present trial aims at examining whether antiplatelet regimen modification, guided by assessment of the on-treatment platelet reactivity, might result with clinical benefit in moderate to high-risk patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). BACKGROUND: High platelet reactivity has been associated with an increased rate of ischemic events after PCI. Recent large trials did not show a clinical benefit of platelet reactivity-guided therapy modification in acute coronary syndrome patients treated by PCI. METHODS: PLATFORM is an investigator-initiated, prospective, randomized, parallel-group, controlled clinical trial. Approximately 632 STEMI patients with intermediate to high-risk (RISK-PCI score >3) clinical features undergoing PPCI will be randomly allocated to treatment modification or standard therapy. Low responders to aspirin will receive 200 mg aspirin for 30 days. Low responders to clopidogrel will receive 180 mg ticagrelor for 1 year. The primary end-point is the time to the first composite major adverse cardiovascular events (MACE) including death, nonfatal infarction, stroke, or immediate target vessel revascularization. Key safety end-point is the rate of TIMI major bleeding unrelated to coronary artery bypass graft surgery. Our secondary end-points are individual components of MACE, definite stent thrombosis, total bleeding, and the need for blood transfusions. Patients will be followed-up at 30 days and at 1 year after PPCI. CONCLUSION: PLATFORM will determine whether the platelet reactivity-guided use of ticagrelor in combination with 200 mg aspirin, compared with standard antiplatelet regimen, improves clinical outcome in moderate to high-risk STEMI patients undergoing PPCI. CLINICAL TRIAL REGISTRATION: U.S. National Institutes of Health (NIH) at www.clinicaltrials.gov. ClinicalTrials.gov Identifier: NCT01739556, and Current Controlled Trials at www.controlledtrials.com. International Standard Randomized Controlled Trial Number ISRCTN83081599.
  Journal of Interventional Cardiology 02/2013; · 1.18 Impact Factor
• Article: B-type natriuretic peptide predicts new-onset atrial fibrillation in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.

  Milika Asanin, Sanja Stankovic, Igor Mrdovic, Dragan Matic, Lidija Savic, Nada Majkic-Singh, Miodrag Ostojic, Zorana Vasiljevic
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  ABSTRACT: The predictive value of B-type natriuretic peptide (BNP) with respect to the occurrence of new-onset atrial fibrillation (AF) in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) is unknown. The aim of this study was to evaluate whether BNP has a predictive value for the occurrence of new-onset AF in patients with STEMI treated by primary PCI. In 180 patients with STEMI treated by primary PCI, BNP concentrations were measured 24h after chest pain onset. The Receiver Operating Characteristic analysis was performed to identify the most useful BNP cut-off level for the prediction of AF. The patients were divided into the two groups according to calculated cut-off level: high BNP group (BNP≥720 pg/mL, n=33) and low BNP group (BNP<720 pg/mL, n=147). The incidence of AF was 5.0%, and occurred more frequently in high BNP group (7/33, 21.2%) than in low BNP group (2/147, 1.4%), (p<0.001). Patients with high BNP were older (p=0.017), had more often anterior wall infarction (p=0.015), higher Killip class on admission (p=0.038), higher peak troponin I (p=0.002), lower left ventricular ejection fraction (p=0.029) than patients with low BNP. After multivariate adjustment, BNP was an independent predictor of AF (OR 3.70, 95% CI 1.40-9.77, p=0.008). BNP independently predicts the occurrence of new-onset AF in STEMI patients treated by primary PCI.
  Peptides 03/2012; 35(1):74-7. · 2.43 Impact Factor
• Article: Time-dependent changes of myeloperoxidase in relation to in-hospital mortality in patients with the first anterior ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.

  Sanja Stankovic, Milika Asanin, Danijela Trifunovic, Nada Majkic-Singh, Svetlana Ignjatovic, Igor Mrdovic, Dragan Matic, Lidija Savic, Jelena Marinkovic, Miodrag Ostojic, Zorana Vasiljevic
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  ABSTRACT: To analyze the prognostic value of myeloperoxidase (MPO) in relation to in-hospital mortality and to identify the optimum time point for sampling in patients with the first anterior ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). A total of 100 consecutive patients with the first anterior STEMI undergoing pPCI were included. Blood samples were collected at baseline, 4, 8, 12, 18, 24, 48 and 168 hours (h) after pPCI. MPO concentrations have showed a biphasic pattern over time; the highest MPO levels were at4h and 24h after pPCI. In-hospital mortality was 6%. MPO at 24h significantly correlated with troponin I as well as heart failure. After multivariate adjustment, MPO at 24h was an independent predictor of the in-hospital mortality (OR 3.34, 95% CI 1.13-9.86, P=0.029). In patients with the first anterior STEMI treated by pPCI, MPO at 24h after procedure was an independent predictor of the in-hospital mortality.
  Clinical biochemistry 02/2012; 45(7-8):547-51. · 2.02 Impact Factor
• Article: The usefulness of myeloperoxidase in prediction of in-hospital mortality in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.

  Sanja Stankovic, Milika Asanin, Nada Majkic-Singh, Svetlana Ignjatovic, Mirjana Mihailovic, Ivica Nikolajevic, Igor Mrdovic, Dragan Matic, Lidija Savic, Jelena Marinkovic, Miodrag Ostojic, Zorana Vasiljevic
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  ABSTRACT: The predictive value of myeloperoxidase (MPO) in ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) has not been established. The aim of the present study was to investigate MPO as a predictor of in-hospital mortality in STEMI patients treated by primary PCI. Study population consisted of 189 STEMI patients having undergone primary PCI. Plasma MPO level was measured 24 hours after symptom onset using chemiluminescent microparticle immunoassay (Abbott Diagnostics, Germany). The Receiver Operating Characteristic analysis was performed to identify the most useful MPO cut-off level for the prediction of in-hospital mortality. The patients were divided into two groups according to the cut-off MPO level: high MPO group (> or = 840 pmol/L, n = 65) and low MPO group (< 840 pmol/L, n = 124). The high MPO group had significantly more frequent anterior wall infarctions (p < 0.001) and Killip class > 1 on admission (p = 0.013) as well as lower left ventricular ejection fraction (LVEF) (p = 0.011) and higher B-type natriuretic peptide (BNP) (p = 0.029) than the low MPO group. The incidence of in-hospital mortality was 5.8% and was significantly higher in the high MPO group (13.8%) than in the low MPO group (1.6%) (p = 0.001). Multiple logistic regression analysis identified the plasma MPO level as an independent predictor of in-hospital mortality (OR 3.88, 95% CI 1.13 - 13.34, p = 0.031). Plasma MPO level independently predicts in-hospital mortality in STEMI patients treated by primary PCI.
  Clinical laboratory 01/2012; 58(1-2):125-31. · 0.90 Impact Factor
• Article: Utility of lipoprotein-associated phospholipase A2 for prediction of 30-day major adverse coronary event in patients with the first anterior ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.

  Sanja Stankovic, Milika Asanin, Danijela Trifunovic, Nada Majkic-Singh, Aleksandar Miljković, Svetlana Ignjatovic, Igor Mrdovic, Dragan Matic, Lidija Savic, Miodrag Ostojic, Zorana Vasiljevic
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  ABSTRACT: Lipoprotein-associated phospholipase A2 (Lp-PLA2) has been suggested as an inflammatory marker of cardiovascular risk. The predictive value of Lp-PLA2 in ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) has not been established. The aim of this study was to determine whether plasma Lp-PLA2 is a predictor of a major adverse cardiac event (MACE) in patients with the first anterior STEMI treated by primary PCI. This study consisted of 100 consecutive patients with first anterior STEMI who underwent primary PCI within 6 hours of the symptom onset. Plasma Lp-PLA2 level was measured on admission using a turbidimetric immunoassay (diaDexus, Inc., USA). The Receiver Operating Characteristic analysis was performed to identify the most useful Lp-PLA2 cut-off level for the prediction of MACE. The patients were divided into two groups according to the cut-off Lp-PLA2 level: high Lp-PLA2 group (> or = 463 ng/mL, n = 33) and low Lp-PLA2 group (< 463 ng/mL, n = 67). MACE was defined as cardiac death, non-fatal reinfarction, and target vessel revascularization. Patients in the high Lp-PLA2 group had significantly higher total-, LDL-cholesterol, apolipoprotein B levels, and significantly lower estimated glomerular filtration rates compared with the low Lp-PLA2 group. The incidence of 30-day mortality was 18.2% (6/33) in high Lp-PLA2 group, while in the low Lp-PLA2 group no patient died (p < 0.001). The 30-day MACE occurred in 24.2% of the high Lp-PLA2 group and 3% of the low Lp-PLA2 group (p = 0.001). Multiple logistic regression analysis identified the plasma Lp-PLA2 level as an independent predictor of MACE (OR 1.011, 95%CI 1.001 - 1.013, p = 0.037). In patients with first anterior STEMI treated by primary PCI, the plasma Lp-PLA2 level is an independent predictor of 30-day MACE.
  Clinical laboratory 01/2012; 58(11-12):1135-44. · 0.90 Impact Factor
• Article: New insights into the pathogenesis of perinatal hypoxic-ischemic brain injury.

  Brankica Vasiljevic, Svjetlana Maglajlic-Djukic, Miroslava Gojnic, Sanja Stankovic, Svetlana Ignjatovic, Dragana Lutovac
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  ABSTRACT: Pathogenesis of perinatal hypoxic-ischemic brain injury (HIE) is complex. In this study, we examined the role of neuroinflammation, oxidative stress and growth factors in perinatal hypoxic-ischemic brain damage. Ninety neonates (>32 weeks' gestation) with perinatal HIE were enrolled prospectively. Perinatal HIE was categorized into three stages according to the Sarnat and Sarnat clinical scoring system and changes seen on amplitude integrated electroencephalography. Cerebrospinal fluid (CSF) for interleukin-6 (IL-6) and glutathione peroxidase analysis was taken in the first 48 h of life and subsequent CSF for neuron-specific enolase (NSE) and vascular endothelial growth factor (VEGF) analysis 72 h after birth. Neurodevelopmental outcome was assessed at 12 months of corrected gestational age using the Denver Developmental Screening Test. Concentrations of NSE in CSF correlated with severity of HIE (P < 0.0001) and corresponded well with subsequent neurodevelopmental outcome. Concentrations of IL-6 in CSF were markedly increased in neonates with severe HIE (P < 0.0001) and those with subsequent neurological sequels, but were normal in the majority of neonates with mild and moderate HIE. Glutathione peroxidase activity in CSF was significant with the stage of HIE (P < 0.0001) and gestational age (P < 0.0001) and corresponded well with subsequent neurodevelopmental outcome. Advanced stage of HIE was associated with increased concentrations of VEGF in CSF (P < 0.0001). Neurological outcomes at 12 months of age correlated best with CSF level of NSE (P < 0.001) and IL-6 (P < 0.001). Our results suggest that neuroinflammation plays a principal role in perinatal hypoxic-ischemic brain damage and we postulate that oxidative stress and upregulation of VEGF might be important contributing factors in the pathogenesis of hypoxic-ischemic brain injury, particularly in preterm neonates.
  Pediatrics International 11/2010; 53(4):454-62. · 0.63 Impact Factor
• Article: B-type natriuretic peptide in outpatients after myocardial infarction: optimized cut-off value for incident heart failure prediction.

  Mina Radovanovic, Zorana Vasiljevic, Nebojsa Radovanovic, Jelena Marinkovic, Branko Beleslin, Predrag Mitrovic, Sanja Stankovic, Goran Stankovic
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  ABSTRACT: Higher levels of natriuretic peptides were identified in outpatients after myocardial infarction (MI) compared to the healthy population, even in the absence of heart failure (HF). Therefore, we assessed the optimal cut-off value of B-type natriuretic peptide (BNP) in relation to new-onset HF prediction in 79 post-MI patients with preserved left ventricular systolic function (ejection fraction >40%). Plasma BNP was measured by enzyme immunoassay, 6 months after MI and patients were followed-up for the next one year. Cox proportional regression model analysis revealed the independent prognostic value of BNP for HF prediction (p=0.005). As assessed by ROC analysis the optimal cut-off value of BNP was 175 pg/mL (sensitivity 82%; specificity 77%, AUC 0.77), associated with significantly different rates of incident HF by Kaplan-Meier analysis (p=0.001). In this population of outpatients with preserved left ventricular systolic function after MI, BNP strongly correlated with new-onset HF development at the optimal cut-off value of 175 pg/mL.
  Peptides 10/2010; 31(10):1946-8. · 2.43 Impact Factor
• Article: Genetic aspects of ischemic stroke: coagulation, homocysteine, and lipoprotein metabolism as potential risk factors.

  Sanja Stankovic, Nada Majkic-Singh
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  ABSTRACT: Stroke is one of the most common causes of death and long term disability throughout the world. It may be the outcome of a number of monogenic disorders or, more commonly, a polygenic multifactorial disease. Numerous studies have investigated the role of genetics in the pathogenesis of ischemic stroke, with varied and often contradictory results. The candidate 'stroke risk' genes affecting haemostasis (F5, F2, FGA/FGB, F7, F13A1, vWF, F12, SERPINE1, ITGB3/ITGA2B, ITGA2, GP1BA, TPA, TAFI, THBD, PZ, ANX5), homocysteine metabolism (MTHFR, CBS, MTR), and lipid metabolism (apo E, LPL, CETP, ABCA1, apo AI, apo CIII, apo AIV, apo AV, apo B, apo H, apo(a), PON1/2/3, LDLR/LOX-1) are evaluated in this review. By examining meta-analyses and case-control studies, we made a classification of gene/gene polymorphisms according to the degree of association with ischemic stroke risk. The data assembled could be very useful for further meta-analysis and for future clinical applications.
  Critical Reviews in Clinical Laboratory Sciences 01/2010; 47(2):72-123. · 5.25 Impact Factor
• Article: SIRS score on admission and initial concentration of IL-6 as severe acute pancreatitis outcome predictors.

  Pavle Gregoric, Gregoric Pavle, Ana Sijacki, Sijacki Ana, Sanja Stankovic, Stankovic Sanja, Dejan Radenkovic, Radenkovic Dejan, Nenad Ivancevic, Ivancevic Nenad, [......], Popovic Nada, Borivoje Karadzic, Karadzic Borivoje, Lazar Stijak, Branislav Stefanovic, Stefanovic Branislav, Zoran Milosevic, Milosević Zoran, Djordje Bajec, Bajec Djordje
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  ABSTRACT: Early recognition of severe form of acute pancreatitis is important because these patients need more agressive diagnostic and therapeutical approach an can develope systemic complications such as: sepsis, coagulopathy, Acute Lung Injury (ALI), Acute Respiratory Distress Syndrome (ARDS), Multiple Organ Dysfunction Syndrome (MODS), Multiple Organ Failure (MOF). To determine role of the combination of Systemic Inflammatory Response Syndrome (SIRS) score and serum Interleukin-6 (IL-6) level on admission as predictor of illness severity and outcome of Severe Acute Pancreatitis (SAP). We evaluated 234 patients with first onset of SAP appears in last twenty four hours. A total of 77 (33%) patients died. SIRS score and serum IL-6 concentration were measured in first hour after admission. In 105 patients with SIRS score 3 and higher, initial measured IL-6 levels were significantly higher than in the group of remaining 129 patients (72 +/- 67 pg/mL, vs 18 +/- 15 pg/mL). All nonsurvivals were in the first group, with SIRS score 3 and 4 and initial IL-6 concentration 113 +/- 27 pg/mL. The values of C-reactive Protein (CRP) measured after 48h, Acute Physiology and Chronic Health Evaluation (APACHE II) score on admission and Ranson score showed the similar correlation, but serum amylase level did not correlate significantly with Ranson score, IL-6 concentration and APACHE II score. The combination of SIRS score on admission and IL-6 serum concentration can be early, predictor of illness severity and outcome in SAP.
  Hepato-gastroenterology 57(98):349-53. · 0.66 Impact Factor