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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Update on the duration of dual antiplatelet therapy (DAPT)


While the necessity of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) with coronary stenting is undisputed, the optimal duration of DAPT remains a major topic of discussion. Research data supports both prolonged and shortened duration of DAPT in certain situations. The present paper aims to summarize current evidence and give an overview of contemporary treatment options for patients in need of dual antiplatelet therapy.

Key words: dual antiplatelet therapy, acute coronary syndrome

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Effects of a percutaneous coronary intervention or conservative treatment strategy on treatment outcomes in elderly female patients with acute coronary syndrome


Aim. To determine the difference in hospital outcomes between percutaneous coronary intervention (PCI) and conservative treatment of elderly female patients hospitalized for acute coronary syndrome (ACS).

Material and Methods. This controlled study included 123 female patients admitted to the Clinic for heart and cardiovascular diseases University Hospital of Split with a diagnosis of ACS and multiple cardiovascular risk factors. We recorded their habits, history, demographics, presenting symptoms, electrocardiograms, ultrasound results, laboratory tests, diagnostic tests and treatment. We compared these data between the two groups, i.e., those treated with conservative therapy and those treated with PCI.

Results. There were fewer arrhythmias (P<0.001) and episodes of heart failure (P<0.001) during hospitalization in the PCI group than in the conservative therapy group. There was no significant difference in complications between the groups (P=0.887).

Conclusion. Elderly female patients with ACS treated with PCI had less arrhythmias and heart failure during hospitalization than those treated with conservative therapy and there was no difference in complications. These results suggest that even high risk patients have better outcomes after treatment with PCI, and therefore PCI is suggested as first-line treatment in these patients, regardless of risk factors.

Key words: percutaneous coronary intervention, acute coronary syndrome, women

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Do we need additional laboratory markers of ACS?


Biochemical markers are playing an important role in the diagnosis of acute coronary syndrome (ACS). Due to their high sensitivity and absolute specificity for myocardial damage, cardiac troponins represent the most widely used biomarkers for the diagnosis of ACS. Recently, a number of novel biomarkers have been evaluated as alternative markers that would bring added value to the measurement of troponins. This manuscript gives an overview of the most commonly investigated markers in this field.

Key words: acute coronary syndrome, high sensitive troponin, copeptin

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Be careful what you eat and drink; Coprinic and Kounis syndrome in a patient with the Samter`s triad


Allergic reactions to chemicals, food products or even insect bites are encountered all over the world with a variety of manifestations. Symptoms range from the development of a minor rash to life threatening anaphylactic reactions. Sometimes, acute coronary syndrome (ACS) can be registered in such patients, which may have a serious impact on the course and management of the allergic reaction. Mushroom poisoning constitutes the main portion of plant toxicities in Spain. Depending on the type of mushroom, the adverse effects range from mild gastrointestinal (GI) symptoms to major cytotoxic effects resulting in organ failure and death. Coprinopsis atramentaria poisoning is rare but with serious consequences. We report a case of a 27 year old patient with a previous history of mild persistent asthma, nasal polyps and aspirin allergy that arrived to the Emergency Department with dizziness and temor after consuming beer at a party. On arrival to the hospital, the patient suddenly collapsed, with an electrocardiogram (ECG) showing ST elevation in the inferior leads and 3rd degree atrioventricular (AV) block accompanied by urticarial-like lesions. After administration of treatment, the patient and ECG abnormalities improved. A detailed medical history showed that the patient had eaten scrambled mushrooms and beer. Expert analysis demonstrated that the combined consumption of Coprinopsis atramentaria and alcoholic beverages produced a disulfiram-like reaction (Coprinic syndrome) and type I Kounis syndrome. No case like this has been previously reported.

Key words: Kounis syndrome, Coreopsis atramentaria, acute coronary syndrome

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Baseline characteristics, time-to-hospital admission and in-hospital outcomes of patients hospitalized with ST-segment elevation acute coronary syndromes, 2002 to 2005


Objective. The purpose of this study was to retrospectively determine baseline patient characteristics, time-to-hospital admission, utilization of reperfusion therapy and outcomes of patients hospitalized with ST-segment elevation acute coronary syndromes (ACS) between 2002 and 2005, particularly after 24-h primary percutaneous coronary intervention (PCI) was introduced in 2004.
Methods. Included were all patients admitted to the intensive care unit (ICU) from 2002 to 2005 who met the criteria for ACS. Information on patients’ demographic characteristics, medical history, time-to-hospital admission, clinical characteristics on admission, laboratory examinations, ECG findings, treatments, hospital duration, and in-hospital outcomes was collected by completing a standardized case report form.
Results. There was a sustained increase in admissions between 2002 and 2005, altogether 899 patients were hospitalized. A significant decrease in time-to-hospital admission was achieved. More patients arrived within 4-6 hours (16.3% in 2002 vs. 31.5% in 2005) and less after 12 hours (35.0% in 2002 vs. 13.4% in 2005). A significant increase in primary PCI rate was achieved (16.9% in 2002 vs. 90% in 2005, P<0.001). Consequently, the rate of thrombolysis, postponed PCI and nonreperfusion medical therapy decreased. From 2002 to 2005, total in-hospital stay decreased significantly (15.4±13.0 days vs. 7.8±8.5 days, P<0.001), in-hospital mortality insignificantly (11.3% vs. 7.2%).
Conclusion. Despite the significant increase in primary PCI between 2002-2005, there was only an insignificant decrease in in-hospital mortality. Further shortening the time-to-hospital admission and increasing primary PCI among older hemodynamically unstable ACS patients, particularly those with cardiogenic shock, could achieve an additional decrease in mortality.

Key words: acute coronary syndrome, acute myocardial infarction, time-to-hospital admission, prognosis, management, percutaneous coronary intervention, mortality

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