{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T19:03:19Z","timestamp":1793646199503,"version":"4.5.1"},"reference-count":60,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: ST elevation myocardial infarction (STEMI), particularly when complicated by cardiogenic shock (CS), is a critical condition associated with high mortality rates. Identifying predictors of in-hospital mortality can enhance patient management and outcomes. Materials and Methods: This observational, retrospective case\u2013control study included STEMI patients, both complicated and uncomplicated by CS. Additionally, demographics, clinical characteristics, laboratory data and in-hospital mortality rates were analysed for STEMI patients with CS and those without CS. Results: This study included a total of 101 patients with STEMI, of whom 51 (50.5%) had STEMI without CS and 50 (49.5%) had STEMI with CS. No significant differences were observed in demographic characteristics or STEMI risk factors between the two groups. Emergency coronarography was performed in 90.1% of the patients, with successful thrombolysis achieved in 24.5%. Patients with CS exhibited a significantly higher mortality (52%) than those without CS (11.76%). Univariate analysis identified white blood cell counts, CK-MB, CK levels, elevated creatinine and uric acid levels and a reduced left ventricular ejection fraction (LVEF) as predictors of mortality. Logistic regression analysis revealed that LVEF and CK-MB were independent predictors of in-hospital mortality in patients with STEMI and CS. Each 1% increase in LVEF was associated with a reduced mortality risk (HR = 0.89; 95% CI 0.81\u20130.98; p = 0.018), while elevated CK-MB levels were linked to an increased mortality risk (HR = 1; 95% CI 1\u20131.01; p = 0.014). Conclusions: Reduced systolic function and elevated CK-MB levels are key predictors of in-hospital mortality and outcomes in STEMI patients with CS. These findings underscore the importance of early identification and support the development of targeted management strategies aimed at improving outcomes in this high-risk population.<\/jats:p>","DOI":"10.3390\/medicina61040725","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T09:06:51Z","timestamp":1744621611000},"page":"725","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Factors Associated with Mortality Risk in Patients with Cardiogenic Shock Post-ST-Elevation Myocardial Infarction: Insights from a Regional Centre in Northwest Romania"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0267-3199","authenticated-orcid":false,"given":"C\u0103lin Florin","family":"Pop","sequence":"first","affiliation":[{"name":"Department of Cardiology, \u201cConstantin Opri\u015f\u201d Emergency County Hospital, 430031 Baia Mare, Romania"},{"name":"Faculty of Nursing and Health Sciences, University of Medicine and Pharmacy \u201cIuliu Ha\u021bieganu\u201d, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8362-6639","authenticated-orcid":false,"given":"Camelia Alexandra","family":"Coad\u0103","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences, University of Medicine and Pharmacy \u201cIuliu Ha\u021bieganu\u201d, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0687-7180","authenticated-orcid":false,"given":"Mihai","family":"Lupu","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences, University of Medicine and Pharmacy \u201cIuliu Ha\u021bieganu\u201d, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioan Florin","family":"Feren\u021b","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cConstantin Opri\u015f\u201d Emergency County Hospital, 430031 Baia Mare, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana Ioana","family":"Hodas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cConstantin Opri\u015f\u201d Emergency County Hospital, 430031 Baia Mare, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Pintilie","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cConstantin Opri\u015f\u201d Emergency County Hospital, 430031 Baia Mare, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u0103d\u0103lina-\u015etefana","family":"Ursu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cConstantin Opri\u015f\u201d Emergency County Hospital, 430031 Baia Mare, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e35687","DOI":"10.1097\/MD.0000000000035687","article-title":"Comprehensive review of ST-segment elevation myocardial infarction: Understanding pathophysiology, diagnostic strategies, and current treatment approaches","volume":"102","author":"Elendu","year":"2023","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.1016\/j.jacc.2014.08.037","article-title":"Short-and long-term cause of death in patients treated with primary PCI for STEMI","volume":"64","author":"Pedersen","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1002\/ccd.28329","article-title":"SCAI clinical expert consensus statement on the classification of cardiogenic shock","volume":"94","author":"Baran","year":"2019","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/j.cardfail.2022.10.220","article-title":"Cardiogenic Shock Following Acute Myocardial Infarction: Trends Of Incidence, Management, And Outcomes From The National Inpatient Sample Database Perspective","volume":"29","author":"Hurtado","year":"2023","journal-title":"J. Card. Fail."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.jchf.2020.09.005","article-title":"A Standardized and Comprehensive Approach to the Management of Cardiogenic Shock","volume":"8","author":"Tehrani","year":"2020","journal-title":"JACC Heart Fail."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1056\/NEJMoa1208410","article-title":"Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock","volume":"367","author":"Thiele","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"De Luca, L., Mistrulli, R., Scirpa, R., Thiele, H., and De Luca, G. (2023). Contemporary Management of Cardiogenic Shock Complicating Acute Myocardial Infarction. J. Clin. Med., 12.","DOI":"10.3390\/jcm12062184"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1056\/NEJMoa1808788","article-title":"One-year outcomes after PCI strategies in cardiogenic shock","volume":"379","author":"Thiele","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1016\/S2213-2600(21)00172-7","article-title":"Optimising clinical trials in acute myocardial infarction complicated by cardiogenic shock: A statement from the 2020 Critical Care Clinical Trialists Workshop","volume":"9","author":"Arrigo","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2671","DOI":"10.1093\/eurheartj\/ehz363","article-title":"Management of cardiogenic shock complicating myocardial infarction: An update 2019","volume":"40","author":"Thiele","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00392-008-0735-9","article-title":"TIMI 3 flow after primary angioplasty is an important predictor for outcome in patients with acute myocardial infarction","volume":"98","author":"Kammler","year":"2009","journal-title":"Clin. Res. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1056\/NEJM199908263410901","article-title":"Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock","volume":"341","author":"Hochman","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1056\/NEJMoa2307227","article-title":"Extracorporeal Life Support in Infarct-Related Cardiogenic Shock","volume":"389","author":"Thiele","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1056\/NEJMoa2312572","article-title":"Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock","volume":"390","author":"Jensen","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_15","unstructured":"(2025, April 04). Clinical Outcome and Cost-effectiveness of Reduced Noradrenaline by Using a Lower Blood Pressure Target in Patients With Cardiogenic Shock From Acute Myocardial Infarction (NORSHOCK). ClinicalTrials.gov ID NCT05168462, Available online: https:\/\/clinicaltrials.gov\/."},{"key":"ref_16","unstructured":"(2025, April 04). Evaluation of Unloading the Heart in Patients with Cardiogenic Shock Treated with Mechanical Circulatory Support Devices. ISRCTN82431978. Available online: https:\/\/www.isrctn.com\/ISRCTN82431978."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC)","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1002\/ejhf.260","article-title":"Clinical picture and risk prediction of short-term mortality in cardiogenic shock","volume":"17","author":"Harjola","year":"2015","journal-title":"Eur. J. Heart Fail."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1016\/j.jacc.2017.02.027","article-title":"Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction","volume":"69","author":"Fuernau","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.ijcard.2011.11.003","article-title":"The presence of ST-elevation in lead aVR predicts significant left main coronary artery stenosis in cardiogenic shock resulting from myocardial infarction: The Manitoba cardiogenic shock registry","volume":"166","author":"Ducas","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_21","unstructured":"ESC (2015). Atlas of Cardiology, Country Profile Romania, RSC Survey, Survey on Romanian Society of Cardiology, European Society of Cardiology."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"31","DOI":"10.2478\/rjc-2023-0033","article-title":"The workload of the interventional cardiology centers in Romania: A 2022 overview and 2014\u20132022 trends","volume":"34","author":"Predescu","year":"2024","journal-title":"Romanian J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"126","DOI":"10.4244\/EIJV8SPA22","article-title":"Impact of the Romanian national programme for interventional therapy in ST-elevation myocardial infarction","volume":"8","author":"Arafat","year":"2012","journal-title":"EuroIntervention"},{"key":"ref_24","first-page":"295","article-title":"Predictors of in-Hospital Mortality of ST-Segment Elevation Myocardial Infarction Patients Undergoing Interventional Treatment. An Analysis of Data from the RO-STEMI Registry","volume":"10","author":"Cretu","year":"2015","journal-title":"Maedica"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.ahj.2011.03.033","article-title":"The Romanian Acute Heart Failure Syndromes (RO-AHFS) Registry","volume":"162","author":"Chioncel","year":"2011","journal-title":"Am. Heart J."},{"key":"ref_26","unstructured":"Institutul Na\u021bional de Statistic\u0103 (2025, February 08). Rezultate definitive RPL 2021\u2014Recensamantul Populatiei si Locuintelor. Available online: https:\/\/www.recensamantromania.ro\/rezultate-rpl-2021\/rezultate-definitive\/."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1161\/CIRCULATIONAHA.123.064527","article-title":"Standardized definitions for cardiogenic shock research and mechanical circulatory support devices: Scientific expert panel from the shock academic research consortium (SHARC)","volume":"148","author":"Waksman","year":"2023","journal-title":"Circulation"},{"key":"ref_28","first-page":"305","article-title":"Executive Group on behalf of the Joint European Society of Cardiology (ESC)\/American College of Cardiology (ACC)\/American Heart Association (AHA)\/World Heart Federation (WHF). Task Force for the Universal Definition of Myocardial Infarction Fourth Universal Definition of Myocardial Infarction","volume":"13","author":"Thygesen","year":"2018","journal-title":"Circulation"},{"key":"ref_29","first-page":"233","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"16","author":"Lang","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1097\/CCM.0000000000001847","article-title":"Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients\u2014Part II: Cardiac ultrasonography","volume":"44","author":"Levitov","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jjcc.2018.01.007","article-title":"Reduced variability of visual left ventricular ejection fraction assessment with reference images: The Japanese Association of Young Echocardiography Fellows multicenter study","volume":"72","author":"Kusunose","year":"2018","journal-title":"J. Cardiol."},{"key":"ref_32","unstructured":"R Core Team (2023). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Robin, X., Turck, N., Hainard, A., Tiberti, N., Lisacek, F., Sanchez, J.-C., and M\u00fcller, M. (2011). pROC: An open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinform., 12.","DOI":"10.1186\/1471-2105-12-77"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2815","DOI":"10.21105\/joss.02815","article-title":"effectsize: Estimation of Effect Size Indices and Standardized Parameters","volume":"5","author":"Makowski","year":"2020","journal-title":"J. Open Source Softw."},{"key":"ref_35","unstructured":"Champely, S., Ekstrom, C., Dalgaard, P., and Gill, J. (2020). R package, version 1.3-0, Pwr: Basic Functions for Power Analysis, GitHub. Available online: https:\/\/github.com\/heliosdrm\/pwr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1161\/CIRCULATIONAHA.105.606145","article-title":"Familial sudden death is an important risk factor for primary ventricular fibrillation: A case-control study in acute myocardial infarction patients","volume":"114","author":"Dekker","year":"2006","journal-title":"Circulation"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.21037\/jtd-22-394","article-title":"Risk factors for cardiac rupture after acute ST-segment elevation myocardial infarction during the percutaneous coronary intervention era: A retrospective case-control study","volume":"14","author":"Xu","year":"2022","journal-title":"J. Thorac. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.3906\/sag-1601-11","article-title":"A simple risk score in acute ST-elevation myocardial infarction: Modified ACEF(age, creatinine, and ejection fraction) score","volume":"46","author":"Kalayci","year":"2016","journal-title":"Turk. J. Med Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.amjcard.2017.04.005","article-title":"Prognostic Implications of Mid-Range Left Ventricular Ejection Fraction on Patients Presenting With ST-Segment Elevation Myocardial Infarction","volume":"120","author":"Margolis","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_40","first-page":"1482","article-title":"Prognosis in cardiogenic shock after acute myocardial infarction in the intervencional era","volume":"20","author":"Bengtson","year":"1992","journal-title":"Circulation"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.jemermed.2021.09.009","article-title":"Left Ventricular Ejection Fraction Assessment by Emergency Physician-Performed Bedside Echocardiography: A Prospective Comparative Evaluation of Multiple Modalities","volume":"61","author":"Bahl","year":"2021","journal-title":"J. Emerg. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"221","DOI":"10.5811\/westjem.2013.9.16185","article-title":"Visual estimation of bedside echocardiographic ejection fraction by emergency physicians","volume":"15","author":"Bayata","year":"2014","journal-title":"West J. Emerg. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.ijcard.2004.03.027","article-title":"Visually estimated left ventricular ejection fraction by echocardiography is closely correlated with formal quantitative methods","volume":"101","author":"Gudmundsson","year":"2005","journal-title":"Int. J. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/s00063-015-0118-8","article-title":"Predictors of mortality in patients with cardiogenic shock treated with primary percutaneous coronary intervention and intra-aortic balloon counterpulsation","volume":"111","author":"Schwarz","year":"2015","journal-title":"Med. Klin\u2014Intensiv. und Notfallmedizin"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e30426","DOI":"10.1097\/MD.0000000000030426","article-title":"Prognosis of patients with cardiogenic shock following acute myocardial infarction: The difference between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction","volume":"101","author":"Tsai","year":"2022","journal-title":"Medicine"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1016\/S0140-6736(13)61783-3","article-title":"Intraaortic Balloon Pump in cardiogenic shock II (IABP-SHOCK II) trial investigators. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): Final 12 month results of a randomised, open-label trial","volume":"382","author":"Thiele","year":"2013","journal-title":"Lancet"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1161\/CIRCINTERVENTIONS.116.004337","article-title":"Percutaneous mechanical circulatory support devices in cardiogenic shock","volume":"10","author":"Mandawat","year":"2017","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1001\/jama.285.2.190","article-title":"One-Year Survival Following Early Revascularization for Cardiogenic Shock","volume":"285","author":"Hochman","year":"2001","journal-title":"JAMA"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1097\/CCM.0b013e3181b9eb3b","article-title":"Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission","volume":"38","author":"Marenzi","year":"2010","journal-title":"Crit. Care Med."},{"key":"ref_50","first-page":"572","article-title":"Acute kidney injury in cardiogenic shock: Definitions, incidence, haemodynamic alterations, and mortality","volume":"20","author":"Haapio","year":"2017","journal-title":"Eur. J. Heart Fail."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ejim.2022.01.018","article-title":"Uric acid associated with acute heart failure presentation in Acute Coronary Syndrome patients","volume":"99","author":"Rebora","year":"2022","journal-title":"Eur. J. Intern. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.atherosclerosis.2011.07.021","article-title":"The association of serum uric acid levels on coronary flow in patients with STEMI undergoing primary PCI","volume":"219","author":"Akpek","year":"2011","journal-title":"Atherosclerosis"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"240","DOI":"10.2459\/JCM.0000000000000634","article-title":"Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention","volume":"19","author":"Crimi","year":"2018","journal-title":"J. Cardiovasc. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"4409","DOI":"10.1093\/eurheartj\/eht310.4409","article-title":"Renal failure in myocardial infarction with cardiogenic shock\u2014Comparison of established and novel biomarkers\u2014A biomarker substudy of the IABP-SHOCK II-trial","volume":"34","author":"Fuernau","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1093\/eurheartj\/ehq161","article-title":"aVR ST elevation: An important but neglected sign in ST elevation acute myocardial infarction","volume":"31","author":"Wong","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e12811","DOI":"10.1111\/anec.12811","article-title":"Prognostic implications of ST-segment elevation in lead aVR in patients with acute coronary syndrome: A meta-analysis","volume":"26","author":"Wang","year":"2021","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_57","first-page":"641","article-title":"Primary PCI in ST-elevation myocardial infarction: Mode of referral and time to PCI","volume":"31","author":"Sousa","year":"2012","journal-title":"Rev. Port. Cardiol. Engl. Ed."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"27","DOI":"10.2478\/jce-2024-0008","article-title":"Critical Appraisal of Medical System Performance for STEMI Management\u2014A Comprehensive Analysis of Time Efficiency","volume":"10","author":"Chioncel","year":"2024","journal-title":"J. Cardiovasc. Emergencies"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s13049-019-0616-4","article-title":"The effects of prehospital system delays on the treatment efficacy of STEMI patients","volume":"27","author":"Piekos","year":"2019","journal-title":"Scand. J. Trauma, Resusc. Emerg. Med."},{"key":"ref_60","unstructured":"(2025, April 04). Available online: https:\/\/www.ms.ro\/ro\/transparenta-decizionala\/acte-normative-in-transparenta\/hot%C4%83r%C3%A2re-de-guvern-pentru-aprobarea-strategiei-na%C8%9Bionale-pentru-combaterea-bolilor-cardiovasculare-%C8%99i-cerebrovasculare-2024-2030\/."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/725\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:14:14Z","timestamp":1760030054000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/725"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,14]]},"references-count":60,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["medicina61040725"],"URL":"https:\/\/doi.org\/10.3390\/medicina61040725","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,14]]}}}