Aims Widespread availability of tertiary hospitals with catheterization facilities, although vigorously promoted, has yet to become a reality in many countries with economy in transition. We sought to evaluate the clinical profile and mortality of patients who were hospitalized with a diagnosis of ST-segment elevation myocardial infarction (STEMI) and either received reperfusion therapy or remained without reperfusion in Eastern Europe. Methods and results Data were obtained from the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC; NCT01218776) on STEMI patients admitted to 57 hospitals in Eastern European countries from January 2010 to February 2015. The primary endpoint was 30-day mortality. Of 7982 patients, 65 (0.8%) had a documented contraindication to reperfusion, 5973 (75.5%) received fibrinolysis ( n = 1032) or underwent primary percutaneous coronary intervention (p-PCI; n = 4941), and 1944 patients (24.6%) did not receive any reperfusion therapy. The overall unadjusted 30-day mortality rate was 7.9%. Thirty-day mortality rates were higher in non-reperfusion patients (16.0 vs. 5.0% in the p-PCI group and 7.4% in fibrinolysis group). The strongest factors associated with not attempting reperfusion therapy among these patients were female sex (OR 1.29 CI 1.07-1.56), age (OR 1.02; CI 1.01-1.03), prior MI (OR 1.79; CI 1.38-2.32), prior cerebrovascular events (OR 1.87; CI 1.30-2.68), chronic kidney disease (OR 1.76; CI 1.22-2.53), Killip class >1 (OR 1.31; CI 1.06-1.62), and time to admission >12 h (OR 15.9; CI 13.1-19.3). Conclusions A substantial number of patients are still not offered any reperfusion therapy in many Eastern European countries with economy in transition, and this was associated with increased 30-day mortality. Time from symptoms onset to admission >12 h was the highest ranking among factors related to lack of reperfusion therapy. Quality improvement efforts should focus on minimizing delay to hospital admission among STEMI patients.

INTRODUCTION The aim of the current study was to investigate the outcomes of coronary reperfusion therapies and ST-segment elevation myocardial infarction (STEMI) in patients of Eastern countries with economies in transition. Federation, and Serbia. The overall population consisted of 23,486 consecutive patients admitted to hospitals from January 1(st) to December 31(st) 2009. Registry data and statistics from the Organization for Economic Cooperation and Development (OECD) countries for the same period were used for comparison (2009-2010). In-hospital mortality was between 4% and 5% in the Western countries. In comparison mortality data were significantly larger in Serbia (10.8%) and Bosnia and Herzegovina (11.2%), intermediate in Russian Federation (7.2%) and similar in Hungary (5.0%). The rates of primary percutaneous coronary intervention (primary PCI) were very low in Bosnia and Herzegovina (18.3%), low in Russian Federation (20.6%) and Serbia (22%), and high in Hungary (70%). Major risk factors for death appear to be lack of reperfusion therapy, longer time delay from symptoms onset to hospital presentation as well as the higher percentage of patients with clinical presentation in Killip class III/IV. CONCLUSION In-hospital STEMI case-fatality rates ranges widely in the former Eastern Bloc countries. Beyond the quality of care provided in hospitals, differences in time delay from symptoms onset to hospital admission may strongly influence STEMI patients' outcome.

We sought to investigate characteristics, treatment, and outcome of octogenarian patients during hospital stay for acute coronary syndrome (ACS) in a transitional country. This is a cohort study of 437 patients ≥ 80 years old, consecutively admitted with a diagnosis of ACS at 14 hospitals in 8 Eastern European countries reporting data to ISACS-TC registry. The primary endpoint was in-hospital mortality. The mean age of the study population was 83.5 years; 50.1% of the patients were women. Females, less frequently than males, had a history of myocardial infarction, smoking habit, and episodes of typical chest pain. But they were more often admitted with left ventricular dysfunction. The rate of reperfusion treatment (29.5%) was very low in patients with ST-elevation myocardial infarction (STEMI). Also, most of the overall study population had a non-invasive approach (women, 79% vs. men, 70.6%; P = 0.042). However, when the coronary anatomy was known, there were no differences in the rates of revascularization between genders. There was no difference in the rates of death between male (21%) and female (21.1%) patients. Univariate and multivariate analyses revealed that the independent predictors ( P < 0.05) of death in octogenarians were systolic blood pressure <100 mmHg (odds ratio [OR], 2.74), Killip class ≥ 2 (OR, 1.71), and STEMI as an index event (OR, 2.01). Evidence-based drugs (beta-blockers, statins, and ACE-inhibitors) had all independent significant protective effect on the hospital outcome. In conclusion, age is relevant in the prognosis of ACS, but its importance should be considered not secondary to other clinical factors.

Cardiologia CROATICA Aim of this article is to present the state-of-the-art antithrombotic therapy for the secondary prevention of cardioembolic stroke due to new ESC, ACC, and ACCP guidelines which are the key-opinion guidelines in atrial fibrillation (AF). The statements are based on CHADS2 scoring calculation as well as newly developed CHA2DS2-VASc. Statements: for the patients (pts) with a history of ischemic stroke (IS) or TIA and AF, including paroxysmal AF, guidelines recommend oral anticoagulation (Grade IA), aspirin (Grade IB), or aspirin and clopidogrel (Grade IB). In pts with a history of IS or TIA and AF, guidelines suggest dabigatran 150 mg bid over adjusted-dose VKA (INR 2.0-3.0) (Grade IIB). ESC guidelines recommend for pts with CHA2DS2VASc Score 2, VKA therapy (INR 2,0-3,0), or direct thrombin inhibitor dabigatran, or an oral direct Xa factor inhibitors — rivaroxaban or apixaban (Grade IA). In pts with a history of IS or TIA and AF, who are unsuitable for or choose not to take an oral anticoagulant, guidelines recommend dual therapy, aspirin and clopidogrel (Grade IB). Recommendation is that oral anticoagulation should generally be initiated within 1 to 2 weeks after stroke onset. Earlier anticoagulation can be considered for pts at low risk of bleeding complications i.e. patients with a small infarct burden and no evidence of hemorrhage on brain imaging. Delaying anticoagulation should be considered for pts at high risk of hemorrhagic complications — those with extensive infarct burden or evidence of significant hemorrhagic transformation on brain imaging. In patients with a history of noncardioembolic IS or TIA, guidelines recommend long-term treatment with aspirin (75-100 mg once daily), clopidogrel (75 mg once daily), aspirin/extended-release dipyridamole (25 mg/200 mg bid), or cilostazol (100 mg bid) (Grade IA), VKA (Grade IB), the combination of clopidogrel plus aspirin (Grade IB), or triflusal (Grade IIB). Of the recommended antiplatelet regimens, guidelines suggest clopidogrel or aspirin/extended-release dipyridamole over aspirin (Grade IIB) or cilostazol (Grade IIC). Conclusions: It is an ongoing trend that recommendations follow CHADS2 scoring calculation as well as CHA2DS2VASc Score. Standard of care is based on net clinical benefit i.e. balance between clinical/prevention benefit and safety profile. Still there is a question mark: what to suggest for patients who are unsuitable for oral anticoagulants, for reasons other than major bleeding risk.

European Society of Cardiology (ESC) National Society Cardiovascular Journals (NSCJs) are high-quality biomedical journals focused on cardiovascular diseases. The Editors’ Network of the ESC devises editorial initiatives aimed at improving the scientific quality and diffusion of NSCJ. In this article we will discuss on the importance of the Internet, electronic editions and open access strategies on scientific publishing. Finally, we will propose a new editorial initiative based on a novel electronic tool on the ESC web-page that may further help to increase the dissemination of contents and visibility of NSCJs. © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights