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Publications (7)26.92 Total impact

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    ABSTRACT: BackgroundVentricular tachycardia (VT) is frequently seen in ischemic settings like acute myocardial infarction with ST segment elevation (STEMI). Endothelial dysfunction (ED) represents inflammation and the loss of all protective features of the endothelium. We aimed to examine the association between VT and ED in patients with STEMI.Material/MethodsThe study included 90 subjects (30 with VT and acute STEMI, 30 with STEMI without VT, and 30 controls). Sera of all subjects were tested on ED markers by enzyme immunoassay: sICAM-1 (intracellular adhesive molecule-1), sVCAM-1 (vascular adhesive molecule-1), P- and E-selectins, and VEGF (vascular endothelial growth factor). In addition, CRP (C-reactive protein) was detected.ResultsSignificantly increased values of low-density lipoprotein, triglycerides, leukocytes, creatinine, and the number of cigarettes smoked were observed among patients with VT+STEMI in comparison to controls. The levels of E-selectin were significantly lower in the VT+STEMI group than in the other groups, while the levels of VCAM-1 were significantly higher in the groups with STEMI and VT+STEMI compared to the controls. Lower levels of VEGF were recorded in STEMI and VT+STEMI groups compared to the control group. A significant correlation between CRP and VCAM-1 in patients with VT +STEMI was demonstrated.ConclusionsWe showed that ED may have a role in the immunopathogenesis of VT in patients with STEMI. The role of sE-selectin and correlation of sVCAM-1 with CRP as possible ED predictive markers in patients with VT+STEMI should be further investigated in a large cohort of patients.
    Medical science monitor: international medical journal of experimental and clinical research 11/2013; 19:1027-1036. · 1.22 Impact Factor
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: PURPOSE: In the last few years, our center has become dedicated to the radial approach with nearly 85% of PCI performed with either left or right radial access route. In time radial approach has become the first choice even in patients with STEMI. The aim of the study was to establish whether the type of access had an influence on the procedure success, procedure and fluoroscopy time, and bleeding complication counted as periprocedural blood loss in STEMI patients undergoing primary PCI. METHODS: In this retrospective analysis, we included 767 patients with STEMI treated in our center with primary PCI from January 1, 2011 to January 5, 2013. Radial approach was used in 523 patients (68.2%) (TR group), divided according to the site of access in either “left” (413 patients; 78.9%) or “right” (110 patients; 21.1%) subgroups. Femoral route was used in 244 patients (TF group). RESULTS: There was no significant difference in procedure success, door-to-balloon time, total procedure time, fluoroscopy time and radiation dose between TR and TF groups. In sub-analysis of TR group, we did not find that left or right side access had any significant influence on any of the analyzed parameters. Also, there were no differences in periprocedural blood loss between TR and TF procedural access route (drop of hemoglobin, TR = 10±10 vs TF = 11±11 g/L, p=0.254), as well as in either left or right TR approach (drop of hemoglobin, left = 10±10 vs right = 10±12 g/L, p=0.254). CONCLUSION: In patients with STEMI undergoing primary PCI in a radial dedicated center, there is no difference in effectiveness, safety, and blood loss between radial and femoral approach. Also there is no significant difference in either left or right radial access type.
    The Journal of invasive cardiology 09/2013; 25(E):6. · 0.82 Impact Factor
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    ABSTRACT: PURPOSE: Radial arterial approach has become the default option for coronary procedures in our cath lab (>90%). However, there are situations when radial arterial approach is not possible (e.g. congenital anomalies, tortuous configurations, radioulnar loop, weak or absent radial pulse secondary to previous puncture or catheterization). In such situations, a common second-line approach is used (femoral or ulnar). Many clinicians considered transbrachial (TB) angiography as a high-risk and obsolete procedure. In literature, the complications rate was unacceptably high (up to 36%). The aim of this retrospective investigation was to evaluate the safety and efficiency of TB approach as alternative to radial approach, especially after unsuccessful radial artery puncture. METHOD: Between April 2011 and 2013 TB coronary angiography in the antecubital region was performed in 22 patients with stable and unstable angina or valvular heart disease. In 11 patients, diagnostic procedure was followed by coronary intervention. Reasons for TB approach were weak radial pulse (10 cases) or unsuccessful radial artery puncture (12 cases). Procedures were performed by three experienced transradial invasive cardiologists (transradial success more than 95%). The catheter size was 6 Fr in all patients. Anticoagulation protocol was used following guidelines (aspirin, clopidogrel, unfractionated heparin) but without glycoprotein IIb/IIIa receptor inhibitors. Major complications were defined as vascular complications requiring blood transfusion or surgery or permanent neurological deficit in the lower limb. Minor complications were defined as vascular complications not requiring blood transfusion or surgery and transient neurological deficit in the lower limb. Standard post-procedural protocol was removal of artery sheath 6 hours after puncture and manual puncture site compression for 10 minutes. RESULTS: Overall success rate was 95.5% (21/22). There were no major complications and we noticed only two minor complications (9%), both hematomas. CONCLUSION: TB approach, when used by dedicated transradialists, seems to be easily feasible, safe, and effective. Local vascular complications could be avoided by cautious and sensitive puncture technique. Other important factors are use of 6 Fr catheters, defensive anticoagulation, and careful observation by the nursing team after sheath withdrawal. TB approach has all advantages of the arm approach over the femoral (early ambulation, patient preference, suitable for patients with severe occlusive aortoiliac disease and for patients with difficulty lying down).
    The Journal of invasive cardiology 09/2013; 25(E):30. · 0.82 Impact Factor
  • Circulation 10/2012; 126(A):16961. · 14.95 Impact Factor
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    ABSTRACT: While drug eluting stents (DES) are being more widely used in ever more patients receiving DES each day, some new complications may be emerging. Stent fractures and hypersensitivity reactions to stents are among recognized complications that can lead to therapeutic dead end from the interventional cardiologist's point of view. We present a case in which we reached therapeutic dead end with a sirolimus eluting stent, i.e. repetitive stent fractures with diffuse microaneurysms along the implanted DES, possibly due to hypersensitivity reaction to parts of the stent.
    Acta clinica Croatica 12/2011; 50(4):609-13. · 0.42 Impact Factor
  • International journal of cardiology 04/2011; 148(2):253-5. · 6.18 Impact Factor
  • Zdravko Babic, Ivo Darko Gabric, Hrvoje Pintaric
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    ABSTRACT: A 28-year-old patient, medical nurse, in 10th week of her second pregnancy suffered ventricular fibrillation just after entering the waiting room of the emergency department. After she was successfully defibrillated, electrocardiography revealed a large acute anteroseptolateral ST elevation myocardial infarction. Urgent coronarography was done (premedication with 300 mg of aspirin and 600 mg of clopidogrel) with 90 min door-to-balloon time. Proximal left anterior descending occlusion was found, primary percutaneous coronary intervention was done using Amazonia CroCo 3.0/12 bare-metal stent, and Thrombolysis in Myocardial Infarction III flow was achieved. During the procedure, the patient was wrapped in lead apron. Because of postresuscitational agitation, procedure was done in intravenous anesthesia. The revealed risk factors were smoking and hypercholesterolemia. PAI-1 gene 4G/4G genotype and Apo E gene E2/E4 genotype were also found. Estimated X-ray dosage that fetus received during the procedure was 0.45 mSv, which is less than the upper safe limit in pregnancy. All drugs given to our patient (clopidogrel, aspirin, ivabradine, bisoprolol, anesthetics, low-molecular-weight heparin, and unfractionated heparin) have B or C Food and Drug Administration Pregnancy Category. Fetal ultrasonography showed normal fetal growth, and, after consultation with our team, the patient decided to maintain the pregnancy. Before discharge echocardiography showed left ventricle of normal size with anteroseptolateral hypokinesia, small apical aneurysm, left ventricular ejection fraction of 40-45%, and diastolic dysfunction grade II, without pulmonary hypertension. At the 36th week of pregnancy, the patient was hospitalized and closely monitored; clopidogrel and aspirin were discontinued, and low-molecular-weight heparin was administered. She gave birth to a normal boy by vaginal delivery with epidural anesthesia and without any complication.
    Catheterization and Cardiovascular Interventions 03/2011; 77(4):522-5. · 2.51 Impact Factor