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From 2002-2005, the patients treated for ACS in Serbia were younger, with higher prevalence of females, and with a higher incidence of STAIM in relation to NSTAIM. The administration of reperfusion therapy in STAIM patients has been increasing significantly, from 24.5% in 2002 to 36.4% in 2005, and was followed by a decrease in hospital mortality rate of 14.8% in 2002 to 8.2% in 2005. Overall mortality of STAIM patients treated with or without thrombolytic therapy gradually decreased from 19% in 2002 to 11.7% in 2005.

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.

Background/Aim: The pharmaco-invasive (PI) therapy is recommended strategy in patients (pts) with ST elevation myocardial infarction (STEMI) unable to undergo timely primary percutaneous coronary intervention (pPCI). The primary endpoint was to find the cohorts of pts who are not treated by any reperfusion therapy (RT) and the second endpoint was to see the outcome of the pts treated with RT, in a transition country without fully applicable PI therapy. Methods:The data used are those of 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 age (≥65 yr), heart failure (Killip II-IV), diabetes, and the time to first medical contact (FMC) (>360 min). In patients without RT, mortality was 15.7%, in pts treated with fibrinolysis (FT) was 10.5% and in pts treated with pPCI was 6.2% (p<0.000). Within 3 hours to FMC, higher in-hospital mortality was in FT pts (FT 8.7% vs. pPCI 4.3%). FT treated patients were older, had more comorbidities and heart failure (HF). However, after propensity score matching, in order to adjust the differences among the pts, the mortality rate remained higher, but not statistically significant (FT 8.8%. vs. pPCI 6.4%). Conclusions:The balance of the best cost-benefit strategies for better use of RT is difficult to achieve in transition countries. The possibility for timely pPCI and PI therapy is not applicable, in high risk patients, older, pts with HF and diabetes, especially. Key words: acute myocardial infarction with ST elevation, reperfusion therapy, transition countries, high-risk patientsZaključak: Primena reperfuzione terapije, uz postignuti idealan balans potrošnje i koristi je teško izvodljiva u zemljama u tranziciji. Mogućnosti za blagovremenu primenu pPCI, kao i FI terapije, posebno su ograničene kod visoko rizičnih, starijih bolesnika, kod bolesnika sa znacima SI, komorbiditetima i dijabetesom.Ključne reči: akutni infarkt miokarda sa ST elevacijom, reperfuziona terapija, zemlje u tranziciji, visoko rizični bolesnici