Shengavit Medical Center

Abstract Background Coronary artery disease is the leading cause of mortality in Armenia. To address the lack of national real-world data on reperfusion practices and outcomes, the Armenian National Registry of Myocardial Infarction (ARMI) was established in December 2023 as the first nationwide prospective STEMI registry. Objectives The primary endpoint of the study was to determine in-hospital mortality rates in patients admitted with STEMI across all participating national centers. The secondary endpoints included assessing 30-day and 12-month cardiovascular mortality, all-cause mortality, and rehospitalization rates. Methods ARMI prospectively enrolled consecutive adults aged 18-93 years presenting with STEMI within 48 hours of symptom onset across 13 specialized hospitals nationwide. Trained investigators collected standardized clinical, procedural, and outcome data using a secure national REDCap electronic database. All patients were followed prospectively for 12 months, with structured assessments at 30 days and 12 months. Enrollment ran from 1 December 2023 to 1 July 2025. Results A total of 2,222 patients were enrolled across all 13 centers. The present analysis includes 1,392 patients with complete follow-up data. The cohort was predominantly male (81.1%; n=1,129), with 18.9% women (n=263). Percutaneous coronary intervention (PCI) was performed in 96.8% of patients (n=2,098), of whom 99.6% underwent primary PCI (n=2,090). Medical therapy alone was used in 2.7% (n=58), and 0.6% (n=12) required coronary artery bypass grafting. In-hospital reinfarction and recurrent ischemia occurred in 3.4% and 4.2% of patients, respectively. Overall in-hospital mortality was 3.1%. Cardiovascular causes accounted for 91.0% of all in-hospital deaths. Reduced systolic function was a major contributor, with 62.5% of deceased patients having LVEF ≤40%. Acute HF with Killip class 3-4 at presentation was identified in 8.0% of patients. In-hospital mortality in patients with Killip class 3-4 was substantially higher at 9.0% versus 3.1% for the overall cohort. At one year, all-cause mortality was 8% in the overall population and 32% in patients presenting with Killip class 3-4, confirming the powerful adverse prognostic impact of early HF severity. HF-related rehospitalization occurred in 13% of Killip class 3-4 patients versus 36% in the overall cohort, reflecting ongoing morbidity burden. Conclusions ARMI establishes the first national benchmark for STEMI care in Armenia, demonstrating near-universal primary PCI use and low in-hospital mortality (3.1%), comparable to that reported in European registries. Acute HF at presentation identified a high-risk subgroup with markedly higher in-hospital and 1-year mortality. Left ventricular ejection fraction ≤40% emerged as a key prognostic marker. The ARMI registry provides a foundation for future translational research and nationwide quality improvement initiatives.

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.

To evaluate the effectiveness of MediNik hydrogel for retrieval of stone fragments of varying sizes and to assess how application technique influences its performance. An in vitro experimental study was conducted using blood sample containers, natural stone fragments ranging from 0.2 to 2 mm, a 7.5 Fr single-use flexible ureteroscope, and a 2.2 Fr endoscopic basket. The MediNik system consists of a blue alginate component (K1) and a yellow calcium-based activator (K2) that interact to form a hydrogel. The evaluated parameters included K1:K2 ratios (2:1, 1:1, 1:2, and 1:3), stone fragment size (0.2–0.45 mm, 0.45–0.6 mm, 0.6–1.0 mm, 1–2 mm, and mixed fragments), application method (surface application versus delivery of K1 into the fragment mixture), and waiting time (3, 5, and 10 s). Hydrogel performance was strongly influenced by the application technique. Effective integration of the two components occurred when K1 was delivered directly into the stone fragments and K2 was subsequently applied, particularly at K1:K2 ratios of 1:1, 1:2, and 1:3. Successful retrieval was achieved across all fragment sizes, including mixed fragments. Surface application of the components alone did not consistently produce a stable hydrogel clot. Stable MediNik hydrogel clot formation was achieved at K1:K2 ratios of 1:1, 1:2, and 1:3 when K1 was applied first and followed by K2, with effective clot formation observed at waiting times of 3, 5, and 10 s. Stone fragment size did not affect clot formation. The most reliable clot suitable for basket extraction was obtained using intrafragment application of the alginate component followed by calcium binder delivery.

Abstract Background SGLT2 inhibitors improve outcomes in patients with chronic heart failure; however, evidence supporting their early use after ST-segment elevation myocardial infarction (STEMI), particularly in patients with preserved left ventricular ejection fraction (LVEF), remains limited. Purpose To explore the clinical and echocardiographic outcomes associated with early dapagliflozin initiation in non-diabetic STEMI patients with preserved LVEF following primary percutaneous coronary intervention (PCI). Methods This prospective, non-randomized study enrolled 100 non-diabetic patients with primary STEMI, LVEF >45%, and successful primary PCI within 24 hours of symptom onset. Fifty patients received standard medical therapy (Control group), while 50 patients additionally received dapagliflozin 10 mg once daily initiated within the first 48 hours of hospitalization (Dapa group). Echocardiography was performed within 24 hours and repeated at one year. The primary endpoint was heart failure hospitalization at one year. Secondary endpoints included cardiovascular mortality, changes in LVEF, renal function, glycosylated hemoglobin levels, and safety outcomes. Results Baseline LVEF was similar between groups (52.1 ± 4.3% in the Dapa group vs. 52.4 ± 4.1% in controls; p=0.72). At one year, LVEF increased modestly in both groups (54.0 ± 4.6% vs. 53.6 ± 4.5%; p=0.68), with no significant difference in LVEF change between groups (Δ +1.9% vs. +1.2%; p=0.41). Heart failure hospitalization occurred in 10% of patients in the Dapa group and 12% in the control group (p=0.75). One-year cardiovascular mortality was 10% and 12%, respectively (p=0.75). Renal function, glycosylated hemoglobin levels, and adverse event rates were comparable throughout follow-up. Conclusions In non-diabetic STEMI patients with preserved LVEF, early dapagliflozin initiation following primary PCI was safe but did not significantly influence left ventricular systolic function, heart failure hospitalization, or cardiovascular mortality at one year. These findings suggest a neutral effect in this population and support the need for larger, adequately powered trials to define whether early SGLT2 inhibition confers benefit in selected post-MI subgroups.

We analyzed international experience of the most common modern bariatric surgical interventions. In case of traditional therapy, no more than 10% of patients with morbid obesity achieve optimal results. Currently, bariatric surgery is the only one that leads to stable weight loss for more than 10 years. We summarized data on the most popular bariatric procedures (laparoscopic longitudinal gastrectomy and Roux-en-Y gastric bypass) available in the Russian and English-language literature published over the past 10 years. Selection was based on relevance of study issue to current understanding of bariatric surgery. Both techniques demonstrated significant efficacy in the treatment of morbid obesity. However, the researchers presented discrete results demonstrating discrepancies in rates of postoperative complications, weight loss and regression of comorbidities. It is necessary to develop a modified surgical technique for more effective management of this patient population.