BACKGROUND:Early diagnosis of acute coronary syndromes (ACS) remains challenging because electrical, mechanical, and biochemical manifestations of myocardial ischemia evolve at different stages of the ischemic cascade. Although electrocardiography (ECG), cardiac biomarkers, and echocardiography are routinely used in clinical practice, these diagnostic modalities are commonly interpreted independently, potentially delaying recognition of myocardial ischemia. Recent advances in artificial intelligence (AI) offer new opportunities to improve diagnostic accuracy through multimodal integration, with echocardiography serving as the central imaging modality. HYPOTHESIS:AI-enhanced echocardiography, integrated with electrocardiographic findings, cardiac biomarkers, and clinical information, may improve the early diagnosis, risk stratification, and clinical management of patients with suspected ACS compared with conventional sequential diagnostic approaches. METHODS:A comprehensive narrative review of contemporary literature was performed to evaluate current evidence regarding AI applications in echocardiography and their integration with ECG and cardiac biomarkers for the diagnosis of ACS. Published studies addressing automated image acquisition, chamber quantification, myocardial deformation analysis, regional wall-motion assessment, multimodal machine-learning models, explainable AI, and clinical implementation were critically reviewed and synthesized. RESULTS:AI has substantially expanded the capabilities of echocardiography by enabling automated image interpretation, quantitative assessment of ventricular function, myocardial strain analysis, and detection of regional wall-motion abnormalities with high reproducibility. When integrated with ECG, serial high-sensitivity cardiac troponin measurements, and clinical variables, multimodal AI systems demonstrate the potential to improve diagnostic accuracy, facilitate earlier identification of myocardial ischemia, reduce diagnostic uncertainty, and support individualized clinical decision-making. Nevertheless, widespread implementation requires prospective multicenter validation, standardized imaging protocols, explainable algorithms, regulatory oversight, and seamless integration into clinical workflows. CONCLUSIONS:AI-enhanced echocardiography represents a promising step toward precision cardiovascular imaging and may become the central imaging component of future multimodal diagnostic pathways for patients with suspected ACS. Integration of structural, functional, electrical, biochemical, and clinical information through AI-supported decision systems has the potential to improve diagnostic performance and optimize emergency cardiovascular care.

Music is a universal human experience with measurable physiological effects. Among these, its influence on heart rate and autonomic regulation has attracted increasing scientific attention. This paper explores the mechanisms through which music affects cardiac function, including neural pathways, emotional processing, and autonomic nervous system modulation. Additionally, it reviews the impact of different musical genres and tempos on heart rate and heart rate variability (HRV), as well as potential clinical applications in cardiology and rehabilitation.

Coronary artery disease (CAD) and chronic kidney disease (CKD) may reciprocally influence each other and increased risk of many complications, especially ischemic and hemorrhagic events, which complicates the treatment and prognosis of these patients (pts). The pts with both diseases heart failure is present in 43% pts and acute myocardial (AMI) in 15% pts; the equivalent proportion in pts with CAD without kidney disease were 18.5% and 6.4% respectively (1). Not only the pts with CKD in advanced stage 4 or 5 are at high risk of CAD morbidity and mortality but, also the patients with early stage of CKD and without clinical manifestation of vascular disease (2,3). The co-existence of two diseases are strongly interrelated, and explanations could be in the same risk factors responsible for both diseases progression. The prevention of risk factors is key and possible for a better prognosis and treatment options for these pts. Traditional and mutual risk factors of CAD and CKD are age, hypertension, diabetes mellitus, dyslipidemia, tobacco use, obesity, family history and male gender. Some of these factors, as high blood pressure, glucose, lipid levels, tobacco use can and should be aggressively modified. A common and very important findings in progression of three risk factors for CKD – hypertension, diabetes and dyslipidemia, is microalbuminuria, which is an essential predictor of identifying those patients at risk of kidney disease risk progression. National Kidney Foundation underlies the importance of early identification and treatment of CKD and its associated comorbid conditions, including cardiovascular disease (4,5).

INTRODUCTION:The current study aims to investigate the blood Hcy levels in patients with CAD and hypertension in Serbia, a country with a high incidence and mortality of both diseases. METHODS:The level of Hcy in the Serbian population was assessed in 123 patients with chronic coronary artery disease (CAD) and hypertension. There were 53 patients with chronic CAD and 70 patients with hypertension (HTA), but without CAD. RESULTS:The Hcy levels were high in both groups of patients (the mean Hcy level of 16.0 ± 7.0 μmol/L) without a statistical difference between the patients in the CAD (14.9 ± 7.3 μmol/L) and hypertension (16.7 ± 6.7 μmol/L) groups. Hypercholesterolemia was found in 81% of the patients with CAD and 92.0% of the patients with HTA, as a common concern across both clinical conditions. It was also found that not a single conventional risk factor (diabetes, hypertension, the smoking status, the family history of CAD, and hyperlipidemia) may individually influence Hcy levels. By contrast, the low levels of vitamin B12 may be related to the high levels of Hcy. CONCLUSION:Given the fact that it is known that various factors interact and influence Hcy levels and associated cardiovascular risks, specific dietary habits, lifestyle and the other Serbia-specific possible factors were done.

Caesarean section is a challenging intervention in patients treated with dual antiplatelet therapy. We present a case of a 32-year-old pregnant woman experiencing large acute myocardial infarction (MI) of the anterolateral wall, complicated by cardiogenic shock in the 38th week of pregnancy, and treated with drug-eluting stent implantation and dual antiplatelet therapy (DAPT) consisting of aspirin and ticagrelor. Less than 24 h after the MI delivery started, an urgent Caesarean section was indicated. As multiplate aggregometry testing showed a relatively insufficient level of ticagrelor platelet inhibition and a moderate level of aspirin platelet inhibition, a Caesarean section was performed without discontinuation of ticagrelor, which was decided due to the need for emergency surgery. Local hemostatic measures including administration of tranexamic acid were applied. The patient did not experience excessive bleeding. A healthy male baby was born. To the best of our knowledge, this is the first reported case of surgery in pregnant women treated with DAPT without ticagrelor discontinuation.

Abstract Patients who have clinical evidence of hypertension (HT) after coronary artery bypass surgery (CABS) have a poor prognosis in expression of acute myocardial infarction (AMI), as one of the MACE. Unrelieved anxiety can produce an increase in sympathetic nervous system activity leading to an increase in cardiac workload. The purpose of this study was to evaluate the effectiveness of music therapy on prognosis of patients with HT and AMI, after CABS. Methods 314 patients (males 78.4%, mean age 59.8±1.2 yrs) with AMI after previous CABS have been selected from the patients consecutively submitted from January 2003 to January 2019. HT was registered in 166 (53.0%) pts with AMI after previous CABS. All patients with HT were randomized and divided in 2 groups: Study group of 83 patients treated with music therapy and Control group of 83 patients with no music therapy. Each patient in study group underwent two sessions of medical therapy (12 minutes) in a day. Both groups were similar in baselines, post-AMI characteristics and post-AMI medical therapy. The plasma cytokine and catecholamine were measured in both groups. Results In the Study group, heart rate was significantly decreased by music therapy (p=0.0196). In the Control group, there were no significant changes in heart rate. Among cytokines (p=0.0160), plasma interleukin-6 (IL-6) (p=0.0179) in the Study group was significantly lower than those in the Control group, as well as plasma adrenaline (p=0.0162) and noradrenalin (p=0.0218) levels. Conclusion This study provides support for the use of musical therapy in patients with HT and AMI after previous CABS. The positive effects of music therapy, in these patients, are probably because of enhanced of parasympathetic activities and reduction of plasma cytokine and catecholamine levels. Funding Acknowledgement Type of funding sources: None.

Abstract It well known that hyperbaric oxygenation (HBO) and erythropoietin (EP) are growth factors. Because of that, it is logical to apply them together as a therapeutic procedure in the regeneration and recovery of the heart muscle. Hyperbaric oxygen therapy has increased the amount of oxygen which “presents” to cardiac muscle, while the use of EP is reduced the intensity of apoptosis of heart muscle. The aim of this study was to analyze if combined therapy of HBO and EP can be usefulness in patients (pts) with heart failure (HF), especially in chronic type of HF. Material and methods The study was designed as a cross-sectional study in the field of new procedures of HF treatment. From January 2017 to January 2019, there were analyzed 92 patients (pts) with chronic HF. There were more men (69.6%). All pts were divided in two groups: Group I – 72 pts (78.3%) with ischemic HF and Group II – 20 pts (21.7%) with non-ischemic HF. Hyperbaric oxygen therapy protocol was defined as protocol for pts with sever cardiac diseases (total of 15 treatment, once daily, on pO2 1.3–1.7 ATA). Recombined EP was administered deeply subcutaneous, every second day 2000 IU, until dose of 18000 IU. In all pts, on admission and one month after therapy, next procedures were arranged: hemoglobin level, distribution of NYHA class, 6-minutes walking test and EF (by radionuclide ventriculography). Results There were no differences between two groups in gender (p=0.0170) and hemoglobin level before and after therapy (p=0.4400). There were significant changes in distribution of NYHA class in both group of pts, from NYHA class III to NYHA class I and II (p=0.0179) one month after therapy, as well as in 6-minutes walking test one month after therapy (p=0.0148), too. Ejection fraction was significantly better in both groups of pts, one month after therapy (p=0.0040). Conclusion The results of this study open up completely new aspects of the combined use of comparative therapeutic procedures with significant final positive effect in the treatment of chronic HF, ischemic, as well as in non-ischemic type of HF. Funding Acknowledgement Type of funding sources: None.

Background/Aim. The pharmacoinvasive (PI) therapy is a recommended strategy in patients (pts) with ST elevation myocardial infarction (STEMI) unable to undergo timely primary percutaneous coronary intervention (p-PCI). The aim of the study was to find out the cohorts of pts who are not treated by any reperfusion therapy (RT) as well to determine the outcome of the pts treated with RT in a transition country without fully applicable PI therapy. Methods. The study analyzed data from the Hospital National Registry for Acute Coronary Syndrome of Serbia (HORACS). Results. The significant predictors of the withdrawing of the application of any RT in the model [c 75.6%, SE 0.004, 95% CI 0.748?0.761)] were a ge ( ? 6 5 years), heart failure (Killip II-IV), diabetes mellitus, and the time to first medical contact (FMC) (> 360 min). In patients without RT, mortality was 15.7%, in pts treated with fibrinolytic therapy (FT) was 10.5%, and in pts treated with pPCI, it was 6.2% (p < 0.000). Within 3 hours to FMC, higher in-hospital mortality was in FT pts (FT 8.7% vs p-PCI 4.3%). FT treated patients were older, had more comorbidities and heart failure (HF). However, after propensity score matching, in order to ad-just the differences among the pts, the mortality rate remained higher in FT pts but not statistically significantly higher than in p-PCI pts (FT 8.8% vs p-PCI 6.4%). Conclusion. The balance of the best cost-benefit strategies for better use of RT is difficult to achieve in transition countries. The possibility for timely p-PCI and PI therapy is especially not applicable in high-risk patients, older pts, pts with HF, and those with diabetes mellitus.

Mortality decline in women to a lesser extent than in men with coronary artery disease (CAD) has provoked a bigger interest in some already existing dilemmas and questions. Many studies carried out in the past three decades did not provide us with precise conclusions. Moreover, various challenges in the prevention, diagnosis, treatment and outcome of CAD in women are still remaining. The meta-analysis and the systematic review conducted in the last years have offered novel approaches to understanding CAD gender disparities in access to care and coronary disease management in women, but women are more likely to experience less favorable short- and long-term outcomes than men do. The reasons for these findings should lie in several known segments in the CAD pathophysiological mechanisms different in women and ultimately leading to a lower quality of care. Clinical presentation in women, which is often characterized by atypical chest pain and a higher prevalence of non-obstructive CAD when evaluated invasively, places women to the false-negative diagnosis of CAD and influences inadequate access to care. Clinical presentation and diagnostic methods, as well as the appropriate treatment options insufficiently examined in women, need to be better defined. The traditional CAD risk factors have a greater impact on women than on men. Unique CAD risk factors only seen in women, have recently been recognized with more attention. However, it is important to note that even in women with obstructive CAD and typical clinical presentation, invasive therapy and pharmacologic therapy are not always implemented as recommended by guidelines as in men. Women are underrepresented in CAD trials, and in current guidelines, gender differences in CAD management have not yet been justified. The underestimation of the risk of CAD in women, followed by its underdiagnosis and undertreatment, might be one of the reasons for a worse prognosis in women in comparison with men.

Introduction/Objective. The aim of this study was to analyze the usefulness and accuracy of artificial neural networks in the prognosis of infarcted patients with previous myocardial surgical revascularization. Methods. The 13 predictor variables per patient were defined as a data set. All the patients were divided into two groups randomly: the training group and the test group, of 1090 patients each. The evaluation of the neural network performance was organized by using the original data, as well as the complementary test data, containing patient data not used for training the network. In generating the file of comparative results, the program compared the actual outcome for each patient with the predicted one. Results. All the results were compared with 2 ? 2 contingency table constructed from sensitivity, specificity, accuracy, and positive?negative prediction. The network was able to predict the outcome with the accuracy of 96.2%, sensitivity of 78.4%, specificity of 100%, positive predictivity of 100%, and negative predictivity of 96%. There was not efficient prognosis of infarcted patients previously operated on using linear discriminant analysis (accuracy 68.3%, sensitivity 66.4%, and positive predictivity 30.2%). Conclusion. This study suggest that a neural network was better for almost all parameters in outcome prognosis of infarcted patients with previous myocardial surgical revascularization.

Objective: There are no data about the prevalence of silent coronary artery disease in asymptomatic severe aortic stenosis patients with normal exercise testing. Importantly, unmasking significant coronary artery disease in patients with aortic stenosis could influence the choice/timing of treatment in these patients. Method: Exercise testing was performed on semi-supine ergobicycle. Cardiopulmonary analysis during exercise testing, echocardiography, and laboratory analysis at rest was done. Standard clinical/electrocardiography criteria were assessed for symptoms/signs of ischemia during/after exercise testing. In patients with normal exercise testing coronary angiography was performed using standard femoral/radial percutaneous approach. Coronary stenosis was considered significant if >70% of vessel diameter or 50%–70% with fractional flow reserve ≤0.8. Results: Total of 96 patients with normal exercise testing were included (67.6 years, 50.6% males). No patient had any complication or adverse event. The P mean was 52.7 mmHg, mean indexed aortic valve area was 0.36 cm 2 /m 2 and left ventricular ejection fraction, 69.5%. 19/96 patients (19.8%) had significant coronary artery disease on coronary angiography. Multivariate logistic regression analysis revealed brain natriuretic peptide and blood glucose as independent predictors of silent coronary artery disease. Brain natriuretic peptide value of 118 pg/ml had sensitivity/specificity of 63%/73% for predicting coronary artery disease (area under the curve 0.727, P = 0.006). Conclusion: Our results are the first to show that in patients with severe aortic stenosis, normal left ventricular ejection fraction,, and normal exercise testing, significant coronary artery disease is present in as many as 1/5 patients. In such patients, further prospective studies are warranted to address the diagnostic value of brain natriuretic peptide in detecting silent coronary artery disease.

Abstract Risk stratification as well as treatment decision in asymptomatic patients with isolated severe aortic stenosis (AS) is matter of ongoing debate. It has been known that gender-specific difference in left ventricular reaction to AS exists. Female gender has also been linked to increased risk of adverse events after surgical AVR but with better outcome after TAVI. We investigated whether there is a gender difference in functional capacity in asymptomatic patients with isolated severe AS. Asymptomatic patients with severe AS were prospectively enrolled and underwent cardiopulmonary stress-echocardiography exercise testing (ESE-CPET) on supine ergobicycle, ramp protocol, 15 W/min. Patients with ischemia positive test were excluded (ECG and/or echo) There were 139 patients, 61 women. There were no gender differences in age (66.36 vs 67.37, p=ns), echo parameters (Vmax 4.54 vs 4.48m/s, AVA 0.62 vs 0.68cm2, and Pmean 52.6 vs 53.8mmHg, all p=ns), LVEF (68.56 vs 70.90%, p=ns), e/E' (12.74 vs 14.45, p=ns), BNP (112.51 vs 110.55 pg/ml, p=ns) and valvulo-arterial impedance (4.65 vs 5.14mm Hg·ml–1·m2, p=0.07). Women had higher body mass index (29.05 vs 26.95, p=0.022), lower VO2max (12.96 vs 17.93 ml/kg/m2, p=0.001) and higher VE/VCO2 slope (33.69 vs 29.01, p=0.003). Univariable and multivariable linear regression analysis were used to test the relation between various clinical and echocardiographic parameters and VO2max. The variables independently associated with the VO2max are shown in table 1, with female gender being the strongest independent predictor of VO2max Conclusion Female gender is independent predictor of decreased functional capacity, even when adjusting for other variables, including BMI and echo markers of AS severity. Further studies are needed to determine whether this finding affects the course and outcome of the disease Funding Acknowledgement Type of funding source: None

The purpose of this study was to evaluate the effectiveness of music therapy for reduction of anxiety and pain in patients with hypertension (HT) and early post-infarction angina (EPA). Most studies have shown that EPA implies an unfavorable long-term prognosis among patients with acute myocardial

Purpose: Previous research has shown that poor health-related quality of life (HRQOL) is associated with adverse long-term prognosis in patients with heart failure (HF); however, there have been inconsistencies among studies and not all of them confirmed the prognostic value of HRQOL. In addition, few studies involved elderly patients and most focused on all-cause mortality and HF-related hospitalization as outcomes. The aim of our study was to determine whether HRQOL is a predictor and an independent predictor of long-term cardiac mortality, all-cause mortality, and HF-related rehospitalization in elderly patients hospitalized with HF. Patients and methods: This prospective observational study included 200 elderly patients hospitalized with HF in Serbia. HRQOL was measured using the Minnesota Living with Heart Failure questionnaire (MLHFQ). The median follow-up period was 28 months. The primary outcome was cardiac mortality, and all-cause mortality and HF-related rehospitalization were secondary outcomes. Survival analysis was conducted using the Kaplan-Meier method and Cox-proportional hazards regression. Results: Subjects with poor HRQOL (higher than the median MLHFQ score) had a higher probability of cardiac mortality (P=0.029) and HF-related rehospitalization (P=0.001) during long-term follow-up. Poor HRQOL was an independent predictor of cardiac mortality (HR: 2.051, 95% CI: 1.260-3.339, P=0.004), all-cause mortality (HR: 1.620, 95% CI: 1.076-2.438, P=0.021), and HF-related rehospitalization (HR: 2.040, 95% CI: 1.290-3.227, P=0.002). Conclusion: HRQOL is an independent predictor of long-term cardiac mortality in elderly patients hospitalized with HF. It also independently predicts all-cause mortality and HF-related rehospitalization. HRQOL could be used as a complementary clinical predictive tool in this patient population.

Introduction/Objective Patients with submassive (intermediate risk) pulmonary embolism (PE) represent a very heterogeneous group, whose therapeutic strategy still questions whether some groups of patients would have net clinical benefit from fibrinolytic therapy (FT). Methods From the institutional pulmonary embolism registry, 116 patients with submassive PE were identified, and the relation of their outcome to FT was analyzed using the propensity score (PS) adjustment. The primary endpoint was the composite of death, in-hospital cardiopulmonary deterioration, or recurrence of PE. Safety outcomes were updated TIMI non-CABG related major and minor bleeding. Results According to Cox regression analysis, the incidence of composite endpoint was significantly lower in patients treated with FT compared to anticoagulant therapy (AT) only (PS adjusted HR 0.22; 95% CI 0.05-0.89; p = 0.039). But, when patients were stratified into four PS quartiles, only patients in the highest PS quartile that received fibrinolysis, had significantly lower composite event rate than patients treated with AT (HR 0.20; 95% CI 0.01-0.56; p = 0.016). The overall mortality of the study group was 5.2% and there was no significant difference between the treatment groups. Total bleeding was significantly more frequent in FT patients (HR 3.07; 95% CI 1.02-13.29; p = 0.047), but not the major one. Conclusion The use of FT was associated with a better outcome compared to AT in patients with submassive PE, but the benefit was mainly driven from those with highest values of PS, i.e. with the highest baseline risk. The rate of major bleeding was not significantly increased by FT.

The present study provides insight into the diversity of 147 Xanthomonas campestris pv. campestris (Xcc) isolates obtained from six Brassica oleracea vegetable crops (broccoli, cabbage, cauliflower, collard greens, kale, kohlrabi) and the winter oilseed rape crop Brassica napus, collected from different regions in Serbia in 2014. The XCF/XCR pathovar‐specific primer set was used for fast preliminary identification. In repetitive sequence‐based PCR (BOX, ERIC and REP) of all isolates, a higher level of genetic diversity was found in winter oilseed rape isolates compared to isolates from the other hosts. ERIC and REP‐PCR showed the highest heterogeneity, with 10 and nine banding patterns, respectively. The REP‐PCR results showed the highest correlation (70%) with those obtained with multilocus sequence analysis (MLSA), performed with 10 housekeeping genes (fusA, gap‐1, gltA, gyrB1, lacF, lepA, rpoD, dnaK, fyuA and gyrB2). Three distinct phylogenetic groups of winter oilseed rape isolates were detected using MLSA. Two genes, gltA and rpoD, showed the greatest ability to identify and discriminate winter oilseed rape Xcc isolates from isolates of the other six hosts. The lepA gene exhibited specific three‐nucleotide changes in sequences of some of the isolates. Results of virulence testing of 18 representative isolates showed statistically significant host–pathogen specialization for Xcc isolates from winter oilseed rape, cauliflower, kale and kohlrabi. In conclusion, oilseed rape isolates are more genetically diverse and show greater specialization to their host in comparison to the rest of the tested isolates from other brassica hosts.

1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Clinical Department of Geriatrics, “Zvezdara” University Hospital, Belgrade, Serbia; 3Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; 4Clinical Department of Cardiology, “Zvezdara” University Hospital, Belgrade, Serbia; 5Department of Physical Medicine and Rehabilitation, “Zvezdara” University Hospital, Belgrade, Serbia Purpose: Previous research has shown that poor health-related quality of life (HRQOL) is associated with adverse long-term prognosis in patients with heart failure (HF); however, there have been inconsistencies among studies and not all of them confirmed the prognostic value of HRQOL. In addition, few studies involved elderly patients and most focused on allcause mortality and HF-related hospitalization as outcomes. The aim of our study was to determine whether HRQOL is a predictor and an independent predictor of long-term cardiac mortality, all-cause mortality, and HF-related rehospitalization in elderly patients hospitalized with HF. Patients and methods: This prospective observational study included 200 elderly patients hospitalized with HF in Serbia. HRQOL was measured using the Minnesota Living with Heart Failure questionnaire (MLHFQ). The median follow-up period was 28 months. The primary outcome was cardiac mortality, and all-cause mortality and HF-related rehospitalization were secondary outcomes. Survival analysis was conducted using the Kaplan–Meier method and Cox-proportional hazards regression. Results: Subjects with poor HRQOL (higher than the median MLHFQ score) had a higher probability of cardiac mortality (P=0.029) and HF-related rehospitalization (P=0.001) during long-term follow-up. Poor HRQOL was an independent predictor of cardiac mortality (HR: 2.051, 95% CI: 1.260–3.339, P=0.004), all-cause mortality (HR: 1.620, 95% CI: 1.076–2.438, P=0.021), and HF-related rehospitalization (HR: 2.040, 95% CI: 1.290–3.227, P=0.002). Conclusion: HRQOL is an independent predictor of long-term cardiac mortality in elderly patients hospitalized with HF. It also independently predicts all-cause mortality and HFrelated rehospitalization. HRQOL could be used as a complementary clinical predictive tool in this patient population.

BACKGROUND:Despite successful primary percutaneous coronary intervention (PCI) after ST-segment elevation myocardial infarction (STEMI), some patients develop left ventricular systolic dysfunction (LVSD) and acute heart failure (HF). Identifying patients with an increased risk of developing LVSD by means of biomarkers may help select patients requiring more aggressive therapy.OBJECTIVES:The aim of this study was to evaluate the relationship between the levels of oxidative stress markers and development of LVSD and acute HF early after STEMI.MATERIAL AND METHODS:The study enrolled 148 patients with the first STEMI, who were treated by primary PCI < 12 h from the onset of symptoms. We assessed the impact of different biomarkers for developing LVSD and acute HF (Killip ≥ 2) including: markers of necrosis - peak creatine kinase (CK), markers of myocardial stretch - B-type natriuretic peptide (BNP), inflammatory markers - C-reactive protein (CRP), leucocyte and neutrophil count, as well as oxidative stress markers - total thiol groups, catalase, superoxide dismutase (SOD) and glutathione reductase (GR).RESULTS:In multivariate analysis, thiol groups, peak CK, anterior wall infarction, and age were predictors of LVEF ≤ 40%. Out of 16 variables significantly associated with the Killip ≥ 2 in univariate logistic regression analysis, 5 appeared to be independently associated with acute HF in multivariate analysis: catalase, BNP, leucocytes, neutrophil count, and size of left atrium.CONCLUSIONS:In this study, we have shown for the first time that thiol groups and catalase are independent predictors of STEMI complication - LVSD and acute HF, respectively. Beside routine used biomarkers of necrosis and myocardial stretch, thiol groups and catalase may provide additional information regarding the risk stratification.

Background: The most common cause of early death in acute myocardial infarction with ST elevation are malignant heart rhythm disorders, generally occurring in the first four hours of myocardial infarction. The incidence of ventricular fibrillation is greatest in the early stage of the myocardial infarction, and sudden cardiac deaths occur most often in outpatient conditions. Case reports: This paper presents a patient whose first manifestation of coronary artery disease was myocardial infarction with ST elevation complicated by early ventricular fibrillation. Rapid measures of cardiopulmonal resuscitation enabled quick establishment of normal sinus rhythm. Primary percutaneous intervention was performed, with revascularization of artery responsible for acute myocardial infarction. In order to reduce ischemic brain damage, therapeutic hypothermia was applied since the patient was presented in post-reanimation coma. Conclusion: Better treatment of patients with cardiac arrest in outpatient conditions and faster revascularization of the infarct artery are crucial for a reduction of mortality in acute myocardial infarction.