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Introduction: Clinical application of rivaroxaban and apixaban does not require therapeutic monitoring. Commercial anti-activated factor X (anti-FXa) inhibition methods for all anti-FXa drugs are based on the same principle, so there are attempts to evaluate potential clinical application of heparin-calibrated anti-FXa assay as an alternative method for direct FXa inhibitors. We aimed to evaluate relationship between anti-FXa methods calibrated with low molecular weight heparin (LMWH) and with drug specific calibrators, and to determine whether commercial LMWH anti-FXa assay can be used to exclude the presence of clinically relevant concentrations of rivaroxaban and apixaban. Materials and methods: Low molecular weight heparin calibrated reagent (Siemens Healthineers, Marburg, Germany) was used for anti-FXa activity measurement. Innovance heparin (Siemens Healthineers, Marburg, Germany) calibrated with rivaroxaban and apixaban calibrators (Hyphen BioMed, Neuville-sur-Oise, France) was used for quantitative determination of FXa inhibitors. Results: Analysis showed good agreement between LMWH calibrated and rivaroxaban calibrated activity (K = 0.76) and very good agreement with apixaban calibrated anti-Xa activity (K = 0.82), respectively. Low molecular weight heparin anti-FXa activity cut-off values of 0.05 IU/mL and 0.1 IU/mL are suitable for excluding the presence of clinically relevant concentrations (< 30 ng/mL) of rivaroxaban and apixaban, respectively. Concentrations above 300 ng/mL exceeded upper measurement range for LMWH anti-FXa assay and cannot be determined by this method. Conclusion: Low molecular weight heparin anti-FXa assay can be used in emergency clinical conditions for ruling out the presence of clinically relevant concentrations of rivaroxaban and apixaban. However, use of LMWH anti-FXa assay is not appropriate for their quantitative determination as an interchangeable method. [ABSTRACT FROM AUTHOR]

Iako intervencijska kardiologija u Hrvatskoj unatrag dvaju desetljeća bilježi napredak, ne nalazimo analizu broja intervencijskih kardioloških zahvata na nacionalnoj razini. Cilj je rada bila analiza broja koronarnih angiografija (CA) i perkutanih koronarnih intervencija (PCI) u razdoblju od 2010. do 2014. godine. Analizirani su dijagnostičko-terapijski postupci iz računa hospitaliziranih bolesnika u Hrvatskoj koji se odnose na CA i PCI u 13 hrvatskih centara. U promatranom je razdoblju prosječna stopa CA bila 4390 na milijun stanovnika godišnje uz porast od 8,5 % u promatranom razdoblju. Prosječna stopa PCI-ja bila je 2208 uz porast od 15 %. Omjer PCI/CA porastao je s 0,48 na 0,52. Od 47 470 PCI-ja učinjenih u Hrvatskoj od 2010. do 2014. godine 18,6 % učinjeno je u Klinici za kardiovaskularne bolesti Magdalena, 13,8 % u Kliničkom bolničkom centru (KBC) Zagreb, 11,9 % u KBC-u Rijeka i 11,3 % u Kliničkoj bolnici Dubrava, dok su ostali centri imali udjele manje od 10 %. Prema broju PCI-ja, sedam hrvatskih centara (54 %) ubrajamo u velike centre, a četiri (30,7 %) među srednje velike centre. Opća bolnica Dubrovnik od 2013. godine ima dovoljan godišnji broj PCI-ja (> 200), dok Opća bolnica Karlovac radi samo CA. Rezultati upućuju na izniman uspjeh hrvatske intervencijske kardiologije u zadnja dva desetljeća. Hrvatska je 2010. godine imala višu stopu PCI-ja od prosjeka članica Organizacije za ekonomsku suradnju i razvoj (OECD) i 21 zemlje članice Europske unije i veći prosječan godišnji rast (26,8 %) od svih analiziranih zemlja, osim Rumunjske. Stopa PCI-ja bila je viša od većine europskih zemalja, osim Njemačke, Belgije, Austrije i Norveške. Za daljnju analizu uspješnosti intervencijskih zahvata i planiranje daljnjeg razvoja nužno je formiranje unificiranoga Hrvatskog registra kardioloških procedura. Although there has been progress in interventional cardiology in Croatia over the last two decades, there has been no analysis of interventional cardiologic procedures at the national level. The aim of this article was to analyze of the number of coronary angiographies (CA) and percutaneous coronary interventions (PCI) in the period from 2010 to 2014. Diagnostic and treatment procedures were analyzed based on the CA and PCI hospital claims of Croatian patients in 13 Croatian centers. The average rate of CA in the observed period was 4 390 per million population annually, with a growth of 8.5% over the observed period. The average rate of PCI was 2 208 with an increase of 15%. The PCI/CA ratio grew from 0.48 to 0.52. Of the 47 470 PCI procedures performed in Croatia between 2010 and 2014, 18.6% were performed in the Magdalena Special Hospital for Cardiovascular Surgery and Cardiology, 13.8% in the University Hospital Centre Zagreb, 11.9% in the University Hospital Centre Rijeka, and 11.3% in the University Hospital Dubrava, while other centers had shares below 10%. Based on PCI numbers, 7 Croatian centers (54%) can be classified as high volume centers, and 4 (30.7%) as medium volume centers. The Dubrovnik General Hospital since 2013 had a sufficient annual number of PCIs (>200), while the Karlovac General Hospital only performed CA. Results indicate that Croatian interventional cardiology has achieved a great success over the last two decades: in 2010, Croatia already had an aboveaverage rate of PCIs compared with the Organization for Economic Co-operation and Development and 21 countries of the European Union, as well as a larger annual growth (26.8%) than all analyzed countries except Romania. PCI rates were higher than most European countries except Germany, Belgium, Austria, and Norway. Further analysis of the success of interventional procedures and further development plans require the formation of a unified Croatian Registry of Cardiologic Procedures. [ABSTRACT FROM AUTHOR]

Aim To determine whether therapeutic hypothermia (TH) improves survival and neurological outcomes in out-ofhospital cardiac arrest (OHCA) survivors. Methods This retrospective cohort study enrolled patients treated for OHCA with a return of spontaneous circulation admitted to the Cardiac Intensive Care Unit from October 2000 until March 2019. Data were collected from medical archives. Propensity score matching was used. The primary endpoint was death during hospital stay and secondary endpoint was cerebral performance category (CPC) score at discharge. Results Out of 152 patients included in the study, 58 (38.7%) underwent TH treatment. After matching (which left 70 patients in the analysis), death during hospital stay occurred less often in TH group (28.6% vs 57.1%, P = 0.029), while the difference in CPC score was not significant. Cox proportional hazards model showed the predictors of death during hospital stay to be TH (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.13-0.68, P = 0.004), initial Glasgow Coma Scale score of 3 (HR 7.55, 95% CI 1.44-39.63, P = 0.017), and heart failure (HR 2.35, 95% CI 1.02-5.34, P = 0.045). TH was not an independent predictor of CPC score. Mann-Whitney U test and linear regression model showed that TH was associated with higher gain in GCS. Conclusion TH was associated with better survival and certain variables suggesting improved neurological outcomes, suggesting that TH is a vital treatment option for comatose OHCA survivors. [ABSTRACT FROM AUTHOR]

Background. Spontaneous recanalization of a chronically occluded artery is rare and reported anecdotally. Case Summary. We report a case of a patient with a chronically occluded right coronary artery, found on a coronary angiography performed due to acute ST elevation myocardial infarction with an occluded circumflex artery as a culprit lesion. Three months later, a follow-up angiography was performed and a recanalization of the occluded right coronary artery was detected. Discussion. There is a possibility that intrinsic fibrinolytic mechanisms with the additional effect of standard antithrombotic drugs administrated after the acute coronary event led to the recanalization. [ABSTRACT FROM AUTHOR]

Aim To evaluate how coronary computed tomographyangiography (CCTA) altered the management and treatment of patients with suspected coronary artery disease (CAD). Methods During 2009, we studied 792 consecutive patients with suspected CAD. CCTA was performed in all patients using a 64-slice dual-source CT scanner and standard scanning protocols. Results After CCTA, obstructive CAD was excluded in 666 patients. During the 12-month clinical follow-up, 98.6% of these patients were free of major adverse cardiac events. Also, the indication for cardiac catheterization (CC) was revoked in 77.2% of patients. It was also revoked in all patients with low Morise pre-test risk, 80.7% with intermediate risk, and 72.6% with high risk. Medical therapy was changed in 54.7% of patients with confirmed CAD. Conclusion CCTA can reliably exclude significant CAD not only in patients with low and moderate risk, but also in those with high risk. It can also reliably replace CC in the majority of elective patients regardless of risk stratification. It can also be useful in risk reclassification and optimization of medical therapy in patients with CAD. [ABSTRACT FROM AUTHOR]

Diet rich in lipids and hyperlipidaemia increases incidence of atrial premature beats and all supraventricular arrhythmias. The aim of the study was to investigate the prevalence of hyperlipidaemia in patients with AV re-entry tachycardia (AVRT) and AV nodal re-entry tachycardia (AVNRT). We conducted a retrospective, cross-sectional, case-control study that included all consecutive patients for whom AVRT or AVNRT was confirmed during electrophysiology study. Age and gender-matched patients admitted to hospital or outpatient clinic for various reasons were randomly included and served as a control group. Hyperlipidaemia was defined according to 2016 European Society of Cardiology guidelines. A total of 1448 subjects were included: 725 patients with AVRT/AVNRT and 723 controls. AVRT/AVNRT patients had high hyperlipidaemia prevalence, which was significantly higher when compared to the control group (50.1 vs. 35.8%, p < 0.001). AVRT patients, with median age of 37.5 years, had hyperlipidaemia prevalence of 45.7%. In a multivariate analysis, hyperlipidaemia was independently associated with AVRT/AVNRT (OR 2.128, p < 0.001), both with AVNRT (OR 1.878, p < 0.001) and AVRT (OR 2.786, p < 0.001). Hypercholesterolemia was significantly more prevalent in patients with AVNRT and AVRT, while this was not the case for hypertriglyceridemia. There were no differences between the AVRT and AVNRT patients regarding hyperlipidaemia prevalence (51.9 vs. 45.7%, p = 0.801), even though AVRT patients were significantly younger (37.5 vs. 48.5, p < 0.001). In conclusion, this is the first study that investigated hyperlipidaemia prevalence in patients with AVRT or AVNRT. AVRT/AVNRT patients had higher prevalence of hyperlipidaemia and higher total and LDL cholesterol levels. [ABSTRACT FROM AUTHOR]

Background: Propafenone is a sodium-channel blocker, class IC antiarrhythmic drug, frequently used to manage supraventricular dysrhythmias, especially atrial fibrillation. We report a self mono-intoxication with propafenone.Case Report: A 68-year-old woman presented with a decreased level of consciousness, hypotension, and electrocardiogram showing QRS widening with atrial asystole and extreme bradycardia < 20 beats/min. After initial stabilization with transcutaneous pacing, laboratory findings detected normal electrolyte ranges and metabolic acidosis, and her medical history revealed availability of propafenone due to paroxysmal atrial fibrillation and depressive syndrome, which led to the suspicion of intoxication. Despite intravenous sodium bicarbonate, calcium, norepinephrine, and aggressive fluid replacement (10% glucose with insulin), hemodynamic stability was not achieved. Temporary intracardiac pacing was implanted. However, even with multiple electrode positions, effective capture could not be achieved. At that time, transcutaneous pacing was also ineffective. Consequently, the patient died in refractory asystole due to complete myocardial nonexcitability. The concentration of 5270 ng/mL of propafenone was found in the blood at autopsy, using gas spectrometry-mass chromatography. It is the third highest reported propafenone lethal concentration and the first case in which the myocardial nonexcitability refractory to intracardiac pacing was seen despite normal electrode position in the right ventricle, with failure to achieve the patient's hemodynamic stability. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of possible propafenone ingestion causing toxicity, which is probably more frequent than previously described, especially because propafenone is widely available due to its use in managing atrial fibrillation, the most common arrhythmia nowadays. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Transradial approach became standard in invasive treatment of coronary artery disease while the same approach is still used rarely among patients who need invasive pheripheral vascular diagnostics. RESULTS: The main advantages of the transradial approach concerning the potential complications are generally well known as well as the advantages in the means of comfort for the patient. In University Hospital Centre "Sestre milosrdnice" from 2011 transradial approach was used in total of 85 cases of invasive diagnostics or interventional treatment. In 25 situations it was used as one of the additional approaches within the main intervention on iliac arteries, whilst in 8 cases the transradial approach was the only vascular access in intervention on iliac arteries. CONCLUSION: Currently the transradial approach is mainly reserved for the interventions on renal arteries or iliacs. Transradial approach is safe and reliable method for invasive diagnostics on peripheral arteries whilst the application of the interventions on arteries of the lower limb just recently started to be applied more often. [ABSTRACT FROM AUTHOR]