1. Impact of cardiac arrest in patients with cardiogenic shock due to ST-elevation myocardial infarctionDanilo Franco, Jan Bělohlávek, Daniel Rob, Tomas Kovarnik, Tomaž Goslar, Miša Fister, Peter Radšel, Raffaele Izzo, Giuseppe Di Gioia, Giovanni Esposito, Marko Noč, 2026, original scientific article Abstract: Background: Cardiogenic shock (CS) frequently complicates ST-elevation myocardial infarction (STEMI) and may be associated with cardiac arrest occurring either as out-of-hospital (OHCA) or in-hospital cardiac arrest (IHCA). Aim: To compare clinical characteristics, coronary anatomy, management and survival among patients with CS without cardiac arrest (STEMI-CS-no CA), CS with OHCA (STEMI-CS-OHCA) and CS with IHCA (STEMI-CS-IHCA). Methods: We conducted a retrospective study including consecutive patients with CS and STEMI undergoing immediate coronary angiography and percutaneous coronary intervention (PCI) who were admitted to two tertiary university hospitals between 2016 and 2025. Results: Among 345 patients, 150 (43.5%) had STEMI-CS-no CA, 120 (34.8%) STEMI-CS-OHCA, and 75 (21.7%) STEMI-CS-IHCA. STEMI-CS-IHCA patients were older, less frequently presented with an initial shockable rhythm (36.0% vs 61.0%, p = 0.002) and had shorter time to return of spontaneous circulation (10.0 vs 19.6 min, p < 0.001) compared to STEMI-CS-OHCA. They had also lower arterial pressure, left ventricular ejection fraction, estimated glomerular filtration rate and higher arterial lactate compared to STEMI-CS-no CA and STEMI-CS-OHCA. Coronary complexity increased progressively with SYNTAX score rising from 18.6 in STEMI-CS-no CA to 21.5 in STEMI-CS-OHCA and to 27.2 in STEMI-CS-IHCA (p < 0.001). At 1-year, all-cause mortality was 67.3% in STEMI-CS-no CA, 78.3% in STEMI-CS-OHCA (p = 0.004) and 82.7% in STEMI-CS-IHCA (p < 0.001) without significant difference between cardiac arrest subgroups (p = 0.555). Conclusion: In STEMI-related CS, concomitant OHCA or IHCA is associated with distinct clinical profiles, coronary anatomy, intensity of treatment and markedly impaired long-term survival.
Keywords: cardiac arrest, cardiogenic shock, ischemia, PCI, prognosis, STEMI, ST-elevation myocardial infarction
Published in DiRROS: 27.07.2026; Views: 176; Downloads: 107
 Full text (330,65 KB)
This document has many files! More... |
2. Early unfractionated heparin treatment in patients with STEMI - trial design and rationaleMiša Fister, Urša Mikuž, Klemen Žiberna, Danilo Franco, Peter Radšel, Matjaž Bunc, Marko Noč, Tomaž Goslar, 2024, original scientific article Abstract: The early unfractionated heparin (UFH) treatment in patients with ST-elevation myocardial infarction (STEMI) is a single-center, open-label, randomized controlled trial. The study population are patients with STEMI that undergo primary percutaneous coronary intervention (PPCI). The trial was designed to investigate whether early administration of unfractionated heparin immediately after diagnosis of STEMI is beneficial in terms of patency of infarctrelated coronary artery (IRA) when compared to established UFH administration at the time of coronary intervention. The patients will be randomized in 1:1 fashion in one of the two groups. The primary efficacy endpoint of the study is Thrombolysis in myocardial infarction (TIMI) flow grades 2 and 3 on diagnostic coronary angiography. Secondary outcome measures are: TIMI flow after PPCI, progression to cardiogenic shock, 30-day mortality, ST-segment resolution, highest Troponin I and Troponin I values at 24 hours. The safety outcome is bleeding complications. The study of early heparin administration in patients with STEMI will address whether pretreatment with UFH can increase the rate of spontaneous reperfusion of infarct-related coronary artery
Keywords: unfractionated heparin (UFH) treatment
Published in DiRROS: 19.06.2026; Views: 239; Downloads: 139
Full text (658,97 KB)
This document has many files! More... |
3. Prevention of air embolism in extracorporeal membrane oxygenation systems : an in vitro study on protection of central venous catheter lumenDanilo Franco, Nejc Krašna, Robert Novak, Giovanni Esposito, Raffaele Izzo, Jan Bělohlávek, Marko Noč, Tomaž Goslar, 2024, original scientific article Abstract: Background and Objectives: This study aimed to investigate the risk and mechanisms of air entry into the extracorporeal membrane oxygenation (ECMO) circuit through the central venous catheter (CVC) in a veno-venous configuration. The primary goal was to assess the impact of different air volumes on ECMO circuit performance at varying pump speeds. Material and Methods: The study utilized a circuit model to simulate ECMO conditions and evaluate the potential entry points of air, specifically through the unprotected lumen of the CVC. Various interventions, such as the use of a closed three-way stopcock or clave, were implemented to assess their efficacy in preventing air entry. Results: The unprotected lumen of the central venous catheter posed a significant risk for air entry into the ECMO circuit. The introduction of a closed three-way stopcock or clave proved effective in preventing air ingress through the central venous catheter. Auditory cues, such as a distinct hissing sound, served as an early warning sign of air presence in the circuit. The study demonstrated that even small volumes of air, as minimal as 1 mL, could pass through the oxygenator at specific pump speeds, and larger volumes could lead to pump dysfunction. Conclusions: The study identified the unprotected lumen of the central venous catheter as a potential entry point for air into the ECMO circuit. The use of a closed three-way stopcock or one-way valve was found to be a reliable protective measure against air infiltration. Early detection through the observation of a hissing sound in the circuit provided a valuable warning sign. These findings contribute to enhancing the safety and performance of ECMO systems by minimizing the risk of air embolism.
Keywords: air embolism, complications, extracorporeal membrane oxygenation, simulation
Published in DiRROS: 12.06.2026; Views: 215; Downloads: 156
Full text (1,59 MB)
This document has many files! More... |
4. Immediate platelet inhibition strategy for comatose out-of-hospital cardiac arrest survivors undergoing percutaneous coronary intervention and mild therapeutic hypothermiaPeter Kordiš, Jernej Berden, Urša Mikuž, Marko Noč, 2024, original scientific article Abstract: Background: Comatose survivors of out-of-hospital cardiac arrest (OHCA) undergoing percutaneous coronary intervention (PCI) and target temperature management (TTM) are at increased risk of stent thrombosis (ST), partly due to delayed platelet inhibition even with more potent P2Y12 agents. We hypothesized that periprocedural cangrelor would induce immediate platelet inhibition, bridging the "P2Y12 inhibition gap". Methods: In our pilot study, we randomized 30 comatose OHCA patients undergoing PCI and TTM (32-34 °C) into cangrelor and control groups. Both groups received unfractioned heparin, acetylsalicylic acid, and ticagrelor via enteral tube. The cangrelor group also received an intravenous bolus of cangrelor followed by a 4 h infusion. Platelet inhibition was measured using VerifyNow® and Multiplate® ADP at baseline and 1, 3, 5, and 8 h post PCI. Results: Patient characteristics did not differ between groups. VerifyNow® showed significantly decreased platelet reactivity with cangrelor at 1 h (30 vs. 221 PRU; p < 0.001) and 3 h (24 vs. 180 PRU; p < 0.001), with differences at 5 and 8 h. Similarly, the proportion of patients with high on-treatment platelet reactivity (HPR) in the cangrelor group was significantly lower at 1 h (0% vs. 67%; p < 0.001) and 3 h (0% vs. 47%; p = 0.007). Multiplate® ADP was also decreased at 1 h (14 vs. 48 U; p < 0.001) and 3 h (11 vs. 42 U; p = 0.001), with no difference at 5 and 8 h. The occurrence of bleeding events was similar in both groups. Conclusions: Cangrelor safely induced immediate and profound platelet inhibition. We observed no significant drug-drug interaction with ticagrelor.
Keywords: cangrelor, cardiac arrest, platelet inhibition, percutaneous coronary intervention, stent thrombosis
Published in DiRROS: 11.06.2026; Views: 194; Downloads: 138
Full text (953,31 KB)
This document has many files! More... |
5. Transcatheter aortic valve implantation in the first 500 patients : a single-center retrospective studyMarko Noč, Aleš Pleskovič, Maja Rojko, Nataša Černič Šuligoj, Branko Cvetičanin, Matjaž Špan, Stamenko Šušak, Rok Stopar, Danijel Petrovič, Naomi Ana Noč, Ana Bošnjak, Nenad Danojević, Miladin Djordjevic, Marjeta Zorc, 2024, original scientific article Abstract: Aim To determine the procedural characteristics, results, and long-term outcomes of the first 500 consecutive patients undergoing transcatheter aortic valve implantation (TAVI) at the MC Medicor International Center for Cardiovascular Diseases Izola (Slovenia). Methods Data were collected from the institutional registry. The date of death was obtained from the National BIRPIS system by using the patient’s health insurance card number. The difference in 30-day mortality was assessed between two consecutive cohorts of 250 patients, patients who received self-expandable (SEV) and those with balloon-expandable (BEV) valves, and between patients ≤80 and >80 years old. Results Between December 2016 and September 2023, 500 patients (80 ± 6 years, 52% men, EuroScore II, 4.09 ± 4.11), including 3.2% with degenerated surgical prosthesis, underwent TAVI. After predilatation (57%), SEV was implanted in 87.5% and BEV in 12.5% of the patients. The mean postprocedural gradient was 10 ± 4 mm Hg, with more than moderate regurgitation in 0.4%. Emergency cardiac/vascular surgery was performed in 1.4%, and stroke occurred in 0.8%. The new permanent pacemaker (PPM) rate decreased from 19% to 7% (P < 0.001) in the second cohort, and the mean postprocedural transaortic gradient was significantly lower after SEV compared with BEV (9 ± 4 vs 13 ± 4 mm Hg; P < 0.001). There was no difference in 30-day mortality between the first and second cohort of 250 patients (1.2% vs 1.2%; P = 1.000), cohorts of 50 patients from number 0 to 500 (0% vs 2.0%; P = 0.391), SEV and BEV groups (0.9% vs 1.6%; P = 0.487), and patients ≤80 and >80 years old (2.0% vs 0.4%; P = 0.119). Conclusion TAVI results in our study are comparable with international standards. PPM rate decreased over time, and postprocedural gradient was lower after SEV. Learning curve, type of valve, and patient age did not affect 30-day mortality.
Keywords: aortic valve, transcatheter implantation, retrospective study
Published in DiRROS: 05.06.2026; Views: 222; Downloads: 186
Full text (304,08 KB)
This document has many files! More... |
6. Endocarditis infecciosa luego del implante de válvula aórtica por cateterismoCarlos M. Fava, Oscar Mendiz, Marko Noč, Horacio Casabé, Marjeta Zorc, Hugo Fraguas, Gaspar Caponi, León R. Valdivieso, Gustavo Lev, Paul Gamboa, 2022, original scientific article Published in DiRROS: 02.06.2026; Views: 247; Downloads: 139
Full text (141,70 KB)
This document has many files! More... |
7. |
8. Patent foramen ovale-associated stroke and COVID-19 vaccinationMaja Rojko, Nataša Černič Šuligoj, Marjeta Zorc, Marko Noč, 2023, original scientific article Abstract: Background: COVID-19 infection has been associated with paradoxical thromboembolism through a patent foramen ovale (PFO) and ischaemic stroke. Such events have not been reported after COVID-19 vaccination. The aim of the present study was to investigate PFO-associated stroke during the mass COVID-19 vaccination in Slovenia. Methods: This prospective study, conducted between 26 December 2020 and 31 March 2022, enrolled consecutive patients (≥18 years) with PFO-associated stroke referred for a percutaneous closure to a single interventional facility in Slovenia. Results: A total of 953,546 people aged between 18 and 70 years received at least one dose of a COVID-19 vaccine approved by the European Medicines Agency. Of the 28 patients presenting with PFO-associated stroke, 12 patients (42.9%) were vaccinated prior to the event, of whom nine were women and three were men, aged between 21 and 70 years. Stroke occurred within 35 days after vaccination in six patients (50%). Clinical presentation included motor dysphasia, paresis, vertigo, ataxia, paraesthesia, headache, diplopia and hemianopia. At hospital discharge, 11 patients (91.6%) had at least one residual ischaemic lesion. Conclusion: A temporal coincidence of COVID-19 vaccination and PFOassociated stroke has been described. A potential cause–effect relationship may only be hypothesised.
Keywords: PFO-associated stroke, COVID-19 vaccination, patent foramen ovale, stroke
Published in DiRROS: 02.06.2026; Views: 309; Downloads: 219
Full text (172,94 KB)
This document has many files! More... |
9. The impact of mild therapeutic hypothermia on platelet reactivity in comatose survivors of cardiac arrest with acute myocardial infarction treated with ticagrelorJulia Maria Umińska, Jakub Ratajczak, Krzysztof Pstrągowski, Katarzyna Buszko, Klaudiusz Nadolny, Tomasz Fabiszak, Klemen Steblovnik, Marko Noč, Jacek Kubica, 2024, original scientific article Abstract: Background: The aim of the study was to assess the antiplatelet effect of ticagrelor in patients with myocardial infarction (MI) after out-of-hospital cardiac arrest (OHCA) treated with percutaneous coronary intervention (PCI) and mild therapeutic hypothermia (MTH) vs. MI patients without OHCA treated with PCI. Methods: The study was designed and performed as a phase IV, single-center, investigator-initiated, prospective, observational study assessing the early pharmacodynamic effect (within first 24 h) of a ticagrelor loading dose (180 mg) in both groups of patients (MTH group vs. MI group). For assessment of ticagrelor pharmacodynamics Multiple Electrode Aggregometry (MEA) was applied. Results: Compared with the MTH group, platelet inhibition was persistently stronger in the MI group over the entire observation period (up to 24 h), with the highest differesnce at 4 hours after loading with ticagrelor (25.8 ± 26.4 vs. 75.8 ± 40.9 U, p = 0.002). As a consequence, there was a higher prevalence of high platelet reactivity in the MTH group, with the most explicit difference at 6 hours after the loading dose of ticagrelor (78% vs. 7%, p < 0.001). Conclusions: In comparison with patients treated with primary PCI for uncomplicated MI, the antiplatelet effect of ticagrelor in patients with MI complicated with OHCA, undergoing MTH and primary PCI, is attenuated and delayed.
Keywords: cardiac arrest, myocardial infarction, hypothermia, ticagrelor, pharmacodynamic, platelets
Published in DiRROS: 01.06.2026; Views: 229; Downloads: 166
Full text (208,72 KB)
This document has many files! More... |
10. Long-term echocardiographic features after percutaneous closure of patent foramen ovaleMaja Rojko, Nataša Černič Šuligoj, Bojana Žvan, Marjeta Zorc, Saibal Kar, Marko Noč, 2026, original scientific article Abstract: Background: There is a lack of studies systematically addressing long-term echocardiographic features after patent foramen ovale (PFO) closure. Thus, the present study investigated long-term echocardiographic features after percutaneous closure of PFO. Methods: This was a single-centre observational study based on the institutional registry of consecutive patients undergoing PFO closure. Clinical and echocardiographic features during the follow-up were investigated. Results: Between 2006 and 2023, 355 consecutive patients underwent PFO closure following transitory ischaemic attack (TIA) or cerebrovascular insult (CVI). Echocardiography immediately after the procedure and at 6 months was performed in 306 (86%) patients, who had repeat examinations at either between 1 and 5 years (median 1.32 years), between 5 and 10 years (median 7.10 years) or after 10 years (median 11.64 years). The percentage of patients with complete closure (no bubbles during the Valsalva manoeuvre) increased from 64% after the procedure to 80% at 6 months (p<0.05), and ranged between 77% and 81% thereafter (NS). Functional closure (≤10 bubbles) was observed in 93% of patients after the procedure and remained between 94% and 97% thereafter (NS). Except for decreased immediate complete closure (60% versus 83%; p<0.001), there was no difference between the Amplatzer PFO occluder and alternative devices. Among the 15 patients with greater than moderate residual shunt, reasons for the shunt were determined in 73% of patients and included leakage at the level of device, fenestration/atrial septal defect and pulmonary arteriovenous malformation. There was no late device embolisation, thrombus formation or pericardial effusion. Clinical follow-up revealed recurrent TIA and CVI rates of 0.11 and 0.06 per 100 patient-years, respectively. Conclusion: We demonstrated high (>90%) and persistent functional PFO closure beyond 10 years, independent of closure device. There was no late device embolisation, thrombus formation or pericardial effusion. Favourable echocardiographic features were associated with very low rates of recurrent TIA or CVI.
Keywords: patent foramen ovale closure, residual shunt, echocardiography
Published in DiRROS: 01.06.2026; Views: 318; Downloads: 213
Full text (961,04 KB)
This document has many files! More... |
