Abstract Background Rhythm and conduction disturbances are critical determinants of ST-elevation myocardial infarction (STEMI) outcomes. While potassium and calcium imbalances are well-established contributors to arrhythmogenesis, the role of serum sodium, a key electrolyte modulating myocardial excitability, remains underexplored in acute STEMI. Purpose To evaluate whether serum sodium concentration independently predicts in-hospital arrhythmias (ventricular tachycardia (VT), ventricular fibrillation (VF), and atrial fibrillation (AF)) in STEMI patients treated with primary percutaneous coronary intervention (pPCI), after adjusting for key covariates. Methods This retrospective cohort study investigated the impact of serum sodium concentration on arrhythmias in 398 adults with acute STEMI who underwent pPCI. We excluded hypo-/hyperkalemia and abnormal glomerular filtration rate (GFR). Patients were stratified into two groups: Group 1 with plasma sodium level ≤140 mmol/L (n = 279), and Group 2 with plasma sodium level >140 mmol/L (n = 119). Baseline characteristics, including GFR, diabetes mellitus (DM), plasma potassium level, and left ventricular ejection fraction (LVEF), were comparable between the groups. Backward stepwise logistic regression (Wald method) assessed predictors of arrhythmia, adjusting for LVEF, potassium, DM, and sodium groups. Results The analysis showed no statistically significant differences in baseline characteristics between Group 1 and Group 2. Specifically, GFR was 106.1 ± 18.1 vs. 109.8 ± 24.2 mL/min/1.73m² (p = 0.84), potassium 4.16 ± 0.40 vs. 4.15 ± 0.40 mmol/L (p = 0.74), DM prevalence 23.3% vs. 19.3% (p = 0.75), and LVEF was 37.99% ± 7.31 vs. 39.64% ± 7.36 (p = 0.067). The mean serum sodium level was 136.7 ± 3.3 mmol/L in Group 1 and 141± 2.3 mmol/L in Group 2 (p = 0.83). Among the study cohort, 25 cases of arrhythmia (including VT, VF, AF) were identified, representing 6.3% of the total population. However, serum sodium levels were not found to be predictive of in-hospital arrhythmias (OR:1.02, 95% CI: 0.94–1.11, p = 0.62). In contrast, reduced LVEF (OR: 0.95, 95% CI: 0.92–0.98, p = 0.001) and potassium levels (OR: 1.89, 95% CI: 1.12–3.20, p = 0.017) emerged as significant predictors of arrhythmic events. Conclusion In this cohort of STEMI patients treated with primary PCI, serum sodium concentration did not independently influence the incidence of in-hospital arrhythmias. These findings suggest that serum sodium concentration (≤140 vs. >140 mmol/L) may not have a clinically significant impact on arrhythmogenesis in acute STEMI.
To evaluate the impact of position of the external end of the ureteral access sheath (UAS) on the regulation and management of intrarenal pressure (IRP) using 4 different scopes with varying working channel diameters. An ex-vivo study evaluating four single-use flexible ureteroscopes was performed. The IRP measurements were performed with the flexible ureteroscopes only and with 10/12Fr and 12/14Fr UASs together with flexible ureteroscopes. The main variable of interest was the position of the external end of the UAS termed as high (30 cm above), middle (15 cm above) and low (at the kidney level). The highest maximal IRPs were recorded with the 9.2Fr PU400A Pusen scope in all settings. Minor differences were noted between the measurements with no UAS and with UAS in high position. Decreasing the end position of the UAS from high to middle and low resulted in significant decline of IRPs, 33.3
Abstract Background Coronary artery disease is the leading cause of mortality in Armenia, accounting for approximately 40% of all deaths. Timely reperfusion therapy is essential in patients with ST-segment elevation myocardial infarction (STEMI), as treatment delays significantly increase mortality. The Armenian National Registry of Myocardial Infarction (ARMI) represents the first nationwide, multicenter STEMI registry in Armenia. Objectives The primary objective was to determine the in-hospital mortality rate among patients with STEMI admitted to participating hospitals. Secondary objectives included comparing 30-day and 12-month cardiovascular and all-cause mortality and rehospitalization rates, assessing the impact of geographic time delays on outcomes, evaluating adherence to international reperfusion guidelines, and establishing a biobank for future translational research. Methods The registry prospectively enrolled consecutive adults aged 18–93 years admitted with STEMI within 48 hours of symptom onset across 13 hospitals nationwide, including major centers in Yerevan and regional sites. Trained investigators collected clinical data using a secure, national REDCap database. Enrollment ran from December 1, 2023, to July 1, 2025. All patients are followed for one year with 30-day and 12-month assessments. Results A total of 2,222 patients were enrolled. The majority were male (81.1%; n=1,786), and 18.9% (n=416) were female. Percutaneous coronary intervention (PCI) was performed in 2,098 patients (96.8%), of whom 2,090 (99.6%) underwent primary PCI. Medical therapy alone was used in 58 patients (2.7%), while 12 patients (0.6%) underwent coronary artery bypass grafting. Reinfarction occurred in 9 patients (3.4%) and recurrent ischemia in 11 patients (4.2%). The in-hospital mortality rate was 3.1% (n=67), of which 91.0% were cardiovascular in origin. Conclusions Initial ARMI data demonstrate near-universal use of guideline-directed reperfusion therapy in Armenia and a favorable in-hospital mortality rate of 3.1%, comparable to outcomes from European STEMI registries. ARMI establishes the first national benchmark for STEMI care in Armenia and provides critical infrastructure for ongoing quality improvement, future clinical trials, and translational research.
Abstract Background and aims Stroke remains a leading cause of mortality and long-term disability worldwide. Understanding temporal trends in stroke events and outcomes is essential for evaluating healthcare system reforms. In Armenia, a National Stroke Program was launched in 2019. This study analyzes national trends in stroke events and mortality from 2015 to 2024. Methods This population-based study used data from the National Health Statistic and Research Center of the National Institute of Health of the Ministry of Health of the Republic of Armenia. Stroke events and mortality (ICD-10 codes I61–I64) for 2015–2024 were analyzed. Annual population-based rates were calculated per 100,000 inhabitants using official population estimates. Temporal trends were assessed descriptively. Results Between 2015 and 2024, stroke event rates increased from 161.0 to 180.6 per 100,000 population, representing a 12.2% overall increase. A temporary decline in reported events was observed in 2020, reflecting reduced healthcare utilization during the COVID-19 period, followed by stabilization thereafter. In contrast, stroke mortality showed a consistent decline, decreasing from 37.0 per 100,000 in 2015 to 27.1 per 100,000 in 2024, corresponding to a 26.8% reduction. The most pronounced mortality decline occurred after 2019, coinciding with the implementation of the National Stroke Program. Conclusions The increase in reported stroke events coincided with the implementation of the National Stroke Program and likely reflects improved detection rather than a true increase in incidence. In contrast, the concurrent decline in stroke mortality suggests improved survival and the effectiveness of organized stroke care. Conflict of interest Nune Yeghiazaryan: nothing to disclose. Marine Balasanyan: nothing to disclose. Lusine Madoyan: nothing to disclose. Manya Margaryan: nothing to disclose. Lilit Barseghyan: nothing to disclose. Manvel Aghasaryan: nothing to disclose. Diana Andreasyan: nothing to disclose. Oganes Ezoyan: nothing to disclose. Gor Buniatyan: nothing to disclose. Figure 1 - belongs to Results
