Background: Cardiovascular diseases ranked first in terms of the number of deaths in Serbia in 2019, with 52,663 deaths. One fifth of those were from ischemic heart disease (IHD), and half of IHD deaths were from acute coronary syndrome (ACS). We present the ACS mortality time trend in Serbia during a 15-year period using the latest available data, excluding the COVID-19 pandemic. Methods: The data on patients who died of ACS in the period from 2005 to 2019 were obtained from the National Statistics Office and processed at the Department of Prevention and Control of Non-communicable Diseases of the Institute of Public Health of Serbia. Number of deaths, crude mortality rates (CR) and age-standardized mortality rates (ASR-E) for the European population were analyzed. Using joinpoint analysis, the time trend in terms of annual percentage change (APC) was analyzed for the female and male population aged 0 to 85+. Age–period–cohort modeling was used to estimate age, cohort and period effects in ACS mortality between 2005 and 2019 for age groups in the range 20 to 90. Results: From 2005 to 2019 there were 90,572 deaths from ACS: 54,202 in men (59.8%), 36,370 in women (40.2%). Over the last 15 years, the number of deaths significantly declined: 46.7% in men, 49.5% in women. The annual percentage change was significant: −4.4% in men, −5.8% in women. Expressed in terms of APC, for the full period, the highest significant decrease in deaths was seen in women aged 65–69, −8.5%, followed by −7.6% for women aged 50–54 and 70–74. In men, the highest decreases were recorded in the age group 50–54, −6.7%, and the age group 55–59, −5.7%. In all districts there was significant decline in deaths in terms of APC for the full period in both genders, except in Zlatibor, Kolubara and Morava, where increases were recorded. In addition, in Bor and Toplica almost no change was observed over the full period for both genders. Conclusions: In the last 15 years, mortality from ACS in Serbia declined in both genders. The reasons are found in better diagnostic and treatment through an organized network for management of ACS patients. However, there are districts where this decline was small and insignificant or was offset in recent years by an increase in deaths. In addition, there is space for improvement in the still-high mortality rates through primary prevention, which at the moment is not organized.

This cross-sectional study evaluates the potential spatial accessibility of primary percutaneous coronary intervention (pPCI) facilities in the Republic of Serbia (RS) for the year 2030. Cardiovascular diseases, specifically acute myocardial infarction (AMI), are major contributors to mortality, requiring immediate intervention to reestablish blood circulation to the heart. This research employs travel time isochrone analysis to assess the percentage of the population residing within three specific time intervals (30, 60, and 90 min) from a pPCI facility. We project the percentage of the population residing within a 30 min travel time interval to be 50% in 2030. Additionally, the percentage of the population residing within the 90 min travel time interval from a pPCI facility, i.e., known as the “golden hour” travel time distance, is around 96%, with some weekly variations that equate to 1%. We utilized additional spatial analysis to identify population clusters that reside beyond the 90 min travel time from a pPCI facility. These results point to specific regions where either additional pPCI facilities or better road connections would most effectively reduce treatment delays. Additionally, the study highlighted the optimal location for a novel pPCI facility, which is the city of Vršac. Our findings underline the need for careful planning in the health system, where location and transport data can directly guide measures to improve access and lower cardiovascular disease (CVD) mortality.

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.