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Rizwanullah, Sial JA, Ali N, Shehzad M. Angiographic characteristics of culprit lesions in infarct related artery and correlation of TIMI score with SYNTAX score to predict extent and severity of coronary artery disease in patients undergoing primary percutaneous coronary interventions. Pak J Med Sci 2024; 40:20-25. [PMID: 38196467 PMCID: PMC10772429 DOI: 10.12669/pjms.40.1.7750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 01/11/2024] Open
Abstract
Objective The current study was designed to explore the relationship of TIMI and SYNTAX risk score to predict the CAD extent and severity in STEMI patients. Methods For this cross-sectional study, 304 STEMI patients undergoing PPCI were enrolled at Department of Interventional Cardiology NICVD Karachi from September 2021 to January 2022. and the TIMI risk score was determined at enrolment. Based on these scorings, the patients were grouped as low, intermediate, and high risk, i.e., a score of ≤ 3, 4 to 7, and ≥ 8, respectively. The SYNTAX scores were utilized to assess the extent of CAD. Results Statistically significant difference was found in symptoms to balloon time (p=0.001), history of diabetes (p=0.006), angina (p=0.011), obesity (p=0.048), STEMI type (p=0.003), Killip classes (p=0.000), Infarct-Related Artery (p=0.006), number of diseased vessels (p<0.01), LMS > 50% (p=0.000), PCI type (p<0.01), collateral circulation (p<0.01), In-hospital mortality (p<0.01), LV support (p<0.01), and post-procedural TIMI flow (p=0.013), among the three TIMI risk groups. Significant correlation was found among TIMI risk score and SYNTAX score. Conclusion It is observed that the TIMI risk scores are highly correlated with the SYNTAX Score in predicting the CAD severity in STEMI patients.
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Affiliation(s)
- Rizwanullah
- Rizwanullah, FCPS Post Fellow Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Jawaid Akbar Sial
- Jawaid Akbar Sial, FCPS Professor of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Nasir Ali
- Nasir Ali, FCPS Post Fellow Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - M. Shehzad
- Muhammad Shehzad, FCPS Post Graduate Trainee, National Institute of Cardiovascular Diseases, Karachi, Pakistan
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Kumar R, Shaikh AH, Kumar A, Solangi BA, Naseer AB, Awan R, Chachar K, Talpur MFH, Saghir T, Sial JA, Qamar N, Karim M, Hakeem A. Age and gender-based categorization of very premature, premature, and non-premature acute myocardial infarction: A comparison of clinical and angiographic profile and in-hospital outcomes. Int J Cardiol 2023; 391:131292. [PMID: 37625483 DOI: 10.1016/j.ijcard.2023.131292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/27/2023] [Accepted: 08/20/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND In this study, we aimed to assess and compare the distribution of demographic and clinical characteristics and composite adverse clinical outcomes after primary percutaneous coronary intervention (PCI) among "very premature", "premature", and "non-premature" patients with "ST-segment elevation acute coronary syndrome (STE-ACS)" presented at a tertiary care center. METHODS We included consecutive patients diagnosed with STE-ACS undergoing primary PCI. The "very premature" was defined as ≤40 years for males and ≤ 45 years for females, "premature" as <55 years for males and < 65 years for females, and "non-premature" as ≥55 years for males and ≥ 65 years for females. Clinical characteristics, angiographic patterns, and hospital course were compared among the three groups. RESULTS In a sample of 4686 patients, 78.8%(3691) were male, and the average age was 55.6 ± 11 years. In total, 12%(561) were categorized as very premature, 38.3%(1797) as premature, and 49.7%(2328) as non-premature. The distribution of clinical characteristics in very premature, premature, and non-premature groups were as follows; hypertension in 44.6% vs. 53.5% vs. 54.9%; p < 0.001, diabetes in 30.3% vs. 36.8% vs. 35.5%; p = 0.018, smoking in 29.6% vs. 23.3% vs. 26.3%; p = 0.005, obesity in 19.4% vs. 18.4% vs. 15.3%; p = 0.008, single vessel diseases in 58.8% vs. 37.8% vs. 28.8%; p < 0.001, and composite adverse clinical outcomes in 14.1% vs. 16.7% vs. 21.8%; p < 0.001, respectively. CONCLUSION In conclusion, we have a substantial burden of premature STE-ACS. Very premature STE-ACS was found to be associated with a better prognosis, but a substantial burden of composite adverse clinical outcomes was also observed.
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Affiliation(s)
- Rajesh Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
| | | | - Ashok Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Ali Bin Naseer
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Romana Awan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Kalsoom Chachar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Nadeem Qamar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Abdul Hakeem
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Kumar R, Shaikh AH, Ahmed R, Siddiqui MN, Rahooja K, Chachar K, Khan MQ, Samad M, Urooj A, Naseer AB, Sial JA, Saghir T, Khan S, Qamar N. Unfolding the reality of the smoking paradox in a South Asian cohort of patients presenting with ST-elevation acute coronary syndrome undergoing primary percutaneous coronary intervention. SAGE Open Med 2023; 11:20503121231206932. [PMID: 37900968 PMCID: PMC10612446 DOI: 10.1177/20503121231206932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives Smoking is a potent risk factor for coronary artery disease, but there is controversy about its protective nature in terms of prognosis in ST-elevation acute coronary syndrome patients undergoing primary percutaneous coronary intervention. So, the main objective of this study is to unfold this controversy in a South Asian population in terms of clinical angiographic parameters and its in-hospital outcomes. Methods In this study, we included 1756 consecutive patients diagnosed with ST-elevation acute coronary syndrome undergoing primary percutaneous coronary intervention. Patients were classified into smokers and non-smokers, and the in-hospital mortality rate was compared. Multivariable logistic regression analysis was performed to evaluate the paradoxical role of smoking. Results Smokers were younger (53.78 ± 11.16 years vs 56.43 ± 11.17 years; p < 0.001) and more frequently men (98.7% vs 69.9%; p < 0.001) and had less diabetes (19.6% vs 44.8%; p < 0.001) and hypertension (38.5% vs 64.9%; p < 0.001). Smokers presented less frequently in Killip III (5.6% vs 8.1%; p < 0.001) and Killip IV (2.5% vs 4.8%; p < 0.001). Smokers mostly had single vessel disease (41.7% vs 34.4%; p = 0.013), whereas non-smokers had the multi-vessel disease and frequently presented with total occlusion of the culprit vessel (64.6% vs 58.8%; p = 0.040). Smokers have significantly lesser mortality (1.8% vs 4.3%; p = 0.009) compared to non-smokers with an odds ratio of 0.41 (95% confidence interval (CI): 0.21-0.82, p = 0.011); however, adjusted odds ratio on multivariable analysis was 0.67 (95% CI: 0.31-1.41, p = 0.290). Conclusions The paradoxical protective role of smoking is the confounding effect of mainly younger age, less coronary artery disease burden, lower prevalence of diabetes and hypertension, and lower Killip III/IV at presentation.
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Affiliation(s)
- Rajesh Kumar
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | | | - Rameez Ahmed
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | | | - Kubbra Rahooja
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Kalsoom Chachar
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | | | - Maryam Samad
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Abiha Urooj
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Ali Bin Naseer
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | | | - Tahir Saghir
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Sohail Khan
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Nadeem Qamar
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
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Kumar R, Ammar A, Qayyum D, Mujtaba M, Siddiqui MN, Khan MQ, Rahooja K, Rasool M, Samad M, Khan N, Sial JA, Saghir T, Qamar N, Hakeem A, Karim M. Increasing Incidence of ST-Elevation Acute Coronary Syndrome in Young South Asian Population, a Challenge for the World? An Assessment of Clinical and Angiographic Patterns and Hospital Course of Premature Acute Myocardial Infarction. Am J Cardiol 2023; 205:190-197. [PMID: 37611409 DOI: 10.1016/j.amjcard.2023.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023]
Abstract
The incidence of premature ischemic heart disease (IHD) is increasing because of urbanization, a sedentary lifestyle, and various other unexplored factors, especially in South Asia. This study aimed to assess the distribution of premature ST-elevation acute coronary syndrome (STE-ACS) with its clinical and angiographic pattern along with hospital course in a contemporary cohort of patients who underwent primary percutaneous intervention at a tertiary care center in the South Asian region. We included consecutive patients of either gender diagnosed with STE-ACS and who underwent primary percutaneous intervention. Patients were stratified based on age as ≤40 years (young) and >40 years (old). Clinical characteristics, angiographic patterns, and hospital course were compared between the 2 groups. Of the total of 4,686 patients, 466 (9.9%) were young (≤40 years). Young patients had a lower prevalence of hypertension (40.8% vs 54.5%, p <0.001), diabetes (26.6% vs 36.4%, p <0.001), metabolic syndrome (14.8% vs 24%, p <0.001), history of IHD (5.8% vs 9.3%, p = 0.013) and a higher frequency of smoking (33% vs 24.7%, p <0.001), positive family history (8.2% vs 3.2%, p <0.001), and single-vessel involvement (60.1% vs 33.2%, p <0.001). The composite adverse clinical outcome occurrence was significantly lower in young patients (14.2% vs 19.5%, p = 0.006). On multivariable analysis, history of IHD in young, whereas age, Killip class III/IV, intubated, arrhythmias on arrival, diabetes, history of IHD, pre-procedure left ventricular end-diastolic pressure, ejection fraction <40%, and slow flow/no-reflow during the procedure were found to be the independent predictors of adverse clinical outcome in old patients. In conclusion, we have a substantial burden of premature STE-ACS, mostly in male patients potentially driven by smoking and positive family history. Despite favorable pathophysiology, with mostly single-vessel hospital courses of STE-ACS in the young equally lethal in nature.
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Affiliation(s)
- Rajesh Kumar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan.
| | - Ali Ammar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Danish Qayyum
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Mustajab Mujtaba
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Maria Noor Siddiqui
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Muhammad Qasim Khan
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Kubbra Rahooja
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Muhammad Rasool
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Maryam Samad
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Naveedullah Khan
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Jawaid Akbar Sial
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Tahir Saghir
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Nadeem Qamar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Abdul Hakeem
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Musa Karim
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
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Solangi BA, Shah JA, Kumar R, Batra MK, Ali G, Butt MH, Nisar A, Qamar N, Saghir T, Sial JA. Immediate in-hospital outcomes after percutaneous revascularization of acute myocardial infarction complicated by cardiogenic shock. World J Cardiol 2023; 15:439-447. [PMID: 37900262 PMCID: PMC10600783 DOI: 10.4330/wjc.v15.i9.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Cardiogenic shock (CS) is a life-threatening complication of acute myocardial infarction with high morbidity and mortality rates. Primary percutaneous coronary intervention (PCI) has been shown to improve outcomes in patients with CS. AIM To investigate the immediate mortality rates in patients with CS undergoing primary PCI and identify mortality predictors. METHODS We conducted a retrospective analysis of 305 patients with CS who underwent primary PCI at the National Institute of Cardiovascular Diseases, Karachi, Pakistan, between January 2018 and December 2022. The primary outcome was immediate mortality, defined as mortality within index hospitalization. Univariate and multivariate logistic regression analyses were performed to identify predictors of immediate mortality. RESULTS In a sample of 305 patients with 72.8% male patients and a mean age of 58.1 ± 11.8 years, the immediate mortality rate was found to be 54.8% (167). Multivariable analysis identified Killip class IV at presentation [odds ratio (OR): 2.0; 95% confidence interval (CI): 1.2-3.4; P = 0.008], Multivessel disease (OR: 3.5; 95%CI: 1.8-6.9; P < 0.001), and high thrombus burden (OR: 2.6; 95%CI: 1.4-4.9; P = 0.003) as independent predictors of immediate mortality. CONCLUSION Immediate mortality rate in patients with CS undergoing primary PCI remains high despite advances in treatment strategies. Killip class IV at presentation, multivessel disease, and high thrombus burden (grade ≥ 4) were identified as independent predictors of immediate mortality. These findings underscore the need for aggressive management and close monitoring of patients with CS undergoing primary PCI, particularly in those with these high-risk characteristics.
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Affiliation(s)
- Bashir Ahmed Solangi
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan.
| | - Jehangir Ali Shah
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Rajesh Kumar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Mahesh Kumar Batra
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Gulzar Ali
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Muhammad Hassan Butt
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Ambreen Nisar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Nadeem Qamar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Tahir Saghir
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Jawaid Akbar Sial
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
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Kumar R, Ammar A, Kumar A, Ali A, Talpur MFH, Rahooja K, Chachar K, Wadhwa A, Sial JA, Saghir T, Khan S, Hakeem A, Qamar N, Karim M. Acute hyperglycemia, a rabble-rouser or innocent bystander? A prospective analysis of clinical implications of acute hyperglycemia in STE-ACS patients. BMC Cardiovasc Disord 2023; 23:406. [PMID: 37596526 PMCID: PMC10439549 DOI: 10.1186/s12872-023-03440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Acute hyperglycemia is considered an independent prognosticator of both in-hospital and long-term outcomes in patients with acute coronary syndrome (ACS). This study aimed To analyze the incidence of acute hyperglycemia and its impact on the adverse in-hospital outcome in patients with STE-ACS undergoing primary percutaneous coronary intervention (PCI). METHODS In this study, we enrolled patients presenting with STE-ACS and undergoing primary PCI at a tertiary care cardiac center. Acute hyperglycemia was defined as random plasma glucose (RBS) > 200 mg/dl at the time of presentation to the emergency room. RESULTS Of the 4470 patients, 78.8% were males, and the mean age was 55.52 ± 11 years. In total, 39.4% (1759) were found to have acute hyperglycemia, and of these, 59% (1037) were already diagnosed with diabetes. Patients with acute hyperglycemia were observed to have a higher incidence of heart failure (8.2% vs. 5.5%; p < 0.001), contrast-induced nephropathy (10.9% vs. 7.4%; p < 0.001), and in-hospital mortality (5.7% vs. 2.5%; p < 0.001). On multivariable analysis, acute hyperglycemia was found to be an independent predictor of mortality with an adjusted odds ratio of 1.81 [1.28-2.55]. Multi-vessel disease (1.73 [1.17-2.56]), pre-procedure left ventricular end-diastolic pressure (LVEDP) (1.02 [1.0-1.03]), and Killip class III/IV (4.55 [3.09-6.71]) were found to be the additional independent predictors of in-hospital mortality. CONCLUSIONS Acute hyperglycemia, regardless of diabetic status, is an independent predictor of in-hospital mortality among patients with STE-ACS undergoing primary PCI. Acute hyperglycemia, along with other significant predictors such as multi-vessel involvement, LVEDP, and Killip class III/IV, can be considered for the risk stratification of these patients.
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Affiliation(s)
- Rajesh Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
| | - Ali Ammar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Ashok Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Ahsan Ali
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Kubbra Rahooja
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Kalsoom Chachar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Anesh Wadhwa
- Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Sohail Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Abdul Hakeem
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Nadeem Qamar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Shah JA, Kumar R, Solangi BA, Khan KA, Ahmed T, Khowaja S, Ali G, Zehra M, Sial JA, Karim M, Saghir T, Qamar N. One-year major adverse cardiovascular events among same-day discharged patients after primary percutaneous coronary intervention at a tertiary care cardiac centre in Karachi, Pakistan: a prospective observational study. BMJ Open 2023; 13:e067971. [PMID: 37037620 PMCID: PMC10111899 DOI: 10.1136/bmjopen-2022-067971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE Knowledge regarding the short-term outcomes after same-day discharge (SDD) post primary percutaneous coronary intervention (PCI) is lacking. In this study, we evaluated 1-year major adverse cardiovascular events (MACE) among SDD patients after primary PCI. DESIGN 1-year follow-up analysis of a subset of patients from an existing prospective cohort study. SETTING Tertiary care cardiac hospital in Karachi, Pakistan. PARTICIPANTS Consecutive patients, from August 2019 to July 2020, with ST segment elevation myocardial infarction who had undergone primary PCI with SDD (within 24 hours) after the procedure by the treating physician and with at least one successful follow-up up to 1 year. OUTCOME MEASURE Cumulative MACE during follow-up at the intervals of 1 week, 1 month, 6 months and 1 year. RESULTS 489 patients were included, with a gender distribution of 83.2% (407) male patients and a mean age of 54.58±10.85 years. Overall MACE rate during the mean follow-up duration of 326.98±76.71 days was 10.8% (53), out of which 26.4% (14/53) events occurred within 6 months of discharge and the remaining 73.6% (39/53) occurred between 6 months and 1 year. MACE was significantly higher among patients with a Zwolle Risk Score (ZRS) ≥4 at baseline, with an incidence rate of 21.9% (16/73) vs 8.9% (37/416; p=0.001) in patients with ZRS≤3 (relative risk 2.88 (95% CI 1.5 to 5.5)). CONCLUSION A significant burden of short-term MACE was identified among SDD patients after primary PCI; most of these events occurred after 6 months of SDD, mainly among patients with ZRS≥4. A systematic risk assessment based on risk stratification modalities such ZRS could be a viable option for SDD patients with primary PCI.
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Affiliation(s)
- Jehangir Ali Shah
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Rajesh Kumar
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Bashir Ahmed Solangi
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Kamran Ahmed Khan
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Tarique Ahmed
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Sanam Khowaja
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Gulzar Ali
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Mehwish Zehra
- Department of Medicine, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Jawaid Akbar Sial
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Musa Karim
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Tahir Saghir
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Nadeem Qamar
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
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Kumar D, Ahmed I, Bardooli F, Saghir T, Sial JA, Khan KA, Farooq F, Chachar TS, Karim M, Kumar H, Bai R, Qamar N. Techniques to Treat Slow-Flow/No-Reflow During Primary Percutaneous Coronary Intervention. Cardiovasc Revasc Med 2023; 47:1-4. [PMID: 36266151 DOI: 10.1016/j.carrev.2022.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to compare TIMI flow after administering intracoronary (IC) medications through various routes for the treatment of slow flow/no-reflow during primary PCI. METHODS Two independent parallel cohorts of the patients who underwent primary PCI for STEMI and developed slow/no-reflow were recruited. Selection of cohort was based on the route of administration of IC medications as proximal or distal. Post administration TIMI follow was compared between the two cohorts. RESULTS A total of 100 patients were included in both, proximal and distal, cohort. Distribution of angiographic, clinical and demographic characteristics was not significant between the two cohorts except prevalence of hypertension, and diabetes mellitus. Frequency of hypertension, and diabetes mellitus were 45 % vs.70 %; p < 0.001 and 28 % vs. 44 %; p = 0.018 among patients in distal and proximal cohort respectively. Final TIMI III flow was achieved in significantly higher number of patients in distal cohort with the frequency of 88 % vs. 76 %; p = 0.027 as compared to proximal cohort. CONCLUSION Administration of IC medication via distal route is observed to be more effective for the treatment of slow flow/no-reflow during primary PCI. Distal route via export catheter or perforated balloon technique should be preferred wherever feasible.
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Affiliation(s)
- Dileep Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
| | - Iftikhar Ahmed
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Fawaz Bardooli
- Mohammed Bin Khalifa Bin Sulman Al Khalifa Cardiac Centre (KMCC), Bahrain
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Kamran Ahmed Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Fawad Farooq
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | | | - Nadeem Qamar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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9
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Kumar R, Ahmed I, Rai L, Khowaja S, Hashim M, Huma Z, Sial JA, Saghir T, Qamar N, Karim M. Comparative analysis of four established risk scores for prediction of in-hospital mortality in patients undergoing primary percutaneous coronary intervention. Am J Cardiovasc Dis 2022; 12:298-306. [PMID: 36743512 PMCID: PMC9890196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/15/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study was conducted to compare the predictive power of Shock Index (SI), TIMI Risk Index (TRI), LASH Score, and ACEF Score for the prediction of in-hospital mortality in a contemporary cohort of ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) at a tertiary care cardiac center of a developing country. METHODS Consecutive patients diagnosed with STEMI and undergoing primary PCI were included in this study. SI, TRI, LASH, and ACEF were computed and their predictive power was assessed as the area under the curve (AUC) on the receiver operating characteristics (ROC) curve analysis for in-hospital mortality. RESULTS We included 977 patients, 780 (79.8%) of which were male, and the mean age was 55.6 ± 11.5 years. The in-hospital mortality rate was 4.3% (42). AUC for TRI was 0.669 (optimal cutoff: ≥17.5, sensitivity: 76.2%, specificity: 45.6%). AUC for SI was 0.595 (optimal cutoff: ≥0.9, sensitivity: 21.4%, specificity: 89.8%). AUC for LASH score was 0.745 (optimal cutoff: ≥0, sensitivity: 76.2%, specificity: 66.9%). AUC for the ACEF score was 0.786 (optimal cutoff: ≥1.66, sensitivity: 71.4%, specificity: 73.5%). CONCLUSION In conclusion, ACEF showed sufficiently high predictive power with good sensitivity and specificity compared to other three scores. These simplified indices based on readily available hemodynamic parameters can be reliable alternatives to the computational complex scoring systems for the risk stratification of STEMI patients.
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Affiliation(s)
- Rajesh Kumar
- National Institute of Cardiovascular Diseases (NICVD)Karachi, Pakistan
| | - Iftikhar Ahmed
- National Institute of Cardiovascular Diseases (NICVD)Hyderabad, Pakistan
| | - Lajpat Rai
- National Institute of Cardiovascular Diseases (NICVD)Hyderabad, Pakistan
| | - Sanam Khowaja
- National Institute of Cardiovascular Diseases (NICVD)Karachi, Pakistan
| | | | - Zille Huma
- National Institute of Cardiovascular Diseases (NICVD)Karachi, Pakistan
| | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD)Karachi, Pakistan
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD)Karachi, Pakistan
| | - Nadeem Qamar
- National Institute of Cardiovascular Diseases (NICVD)Karachi, Pakistan
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD)Karachi, Pakistan
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Shah JA, Ammar A, Khan W, Kumar R, Ali F, Ahmed S, Zehra M, Sial JA, Saghir T, Rehman ZU. Fear of COVID-19 among Healthcare Workers of a Tertiary Care Cardiac Facility Before- and After-Vaccination and Serology. TJI 2022. [DOI: 10.4274/tji.galenos.2022.63935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Shaikh AH, Kumar R, Ammar A, Hussain A, Mengal MN, Khan KA, Qayyum D, Sial JA, Saghir T, Karim M. CHA 2 DS 2 -VASc score, a simple clinical tool for early prediction of no-reflow phenomenon in patients undergoing emergency percutaneous coronary revascularization. J Cardiovasc Thorac Res 2022; 14:122-127. [PMID: 35935384 PMCID: PMC9339737 DOI: 10.34172/jcvtr.2022.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction: Slow flow/no reflow (SF/NR) phenomenon during emergency percutaneous revascularization is a feared complication associated with increased risk of adverse outcomes. CHA2 DS2 -VASc score has been proposed for the risk stratification but a very limited evidences are available regarding the accuracy of this system. Therefore, we conducted this study to assess the predictive value of CHA2 DS2 -VASc score for predicting SF/NR phenomenon during primary percutaneous coronary intervention (PCI).
Methods: This analytical cross-sectional study included 596 consecutive patients undergoing PCI for STEMI at a tertiary care cardiac center of Karachi, Pakistan. Baseline -VASc sore was calculated and development of SF/NR phenomenon during primary PCI was recorded. Predictive value of the score was assessed through area under the curve (AUC) of receiver operating characteristic curve analysis and sensitivity and specificity were computed. Logistic regression analysis was performed to assess the predictive strength of the score. Results: A total of 596 patients were included, mean age was 56.28±11.44 years, and 75.7%(451) were male. The slow/no reflow phenomenon during the procedure was observed in 36.6%(218) of the patients. CHA2 DS2 -VASc≥2 was observed in 50.2%(299) of the patients. The CHA2 DS2 -VASc score was significantly higher in SF/NR patients, 2.06±1.25 vs. 1.37±1.33; P<0.001. The AUC of CHA2 DS2 -VASc score was 0.652 [0.607-0.696], CHA2 DS2 -VASc≥2 had sensitivity and specificity of 65.6% [58.9% to 71.9%] and 58.3% [53.6% to 63.7%] respectively for predicting SF/NR. CHA2 DS2 -VASc≥2 was insignificant on multivariate with odds ratio of 1.48 [0.72 -3.04]; P=0.283.
Conclusion: CHA2 DS2 -VASc risk stratification system has moderate discriminating power for the stratification of SF/NR phenomenon during primary PCI.
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Affiliation(s)
| | - Rajesh Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Ali Ammar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Afzal Hussain
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Kamran Ahmed Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Danish Qayyum
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Kumar R, Ammar A, Saghir T, Sial JA, Khan KA, Shah JA, Shaikh AH, Rizvi SNH, Qamar N, Karim M. Development and Validation of a Novel Risk Stratification Model for Slow-Flow/No-Reflow During Primary Percutaneous Coronary Intervention (the RK-SF/NR Score). Am J Cardiol 2022; 171:32-39. [PMID: 35305786 DOI: 10.1016/j.amjcard.2022.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/07/2022] [Accepted: 01/17/2022] [Indexed: 11/01/2022]
Abstract
In this study, we developed and validated a novel risk stratification model to predict slow-flow/no-reflow (SF/NR) during the primary percutaneous coronary intervention (PCI), namely the RK-SF/NR score. A total of 1,711 consecutive patients with ST-segment elevation myocardial infarction (STEMI) undergone primary PCI. A novel risk stratification model was developed in the development dataset and tested in the validation dataset. The overall incidence rate of SF/NR during the procedure was 28.8% (493/1,711). The final solution consisted of 9 variables: female gender (points = 2), total ischemic time ≥8 hours (points = 1), cardiac arrest at presentation (points = 2), left ventricular end-diastolic pressure ≥24 mm Hg (points = 3), left ventricular ejection fraction ≤30% (points = 2), culprit proximal left anterior descending artery (points = 3), thrombus grade ≥4 (points = 6), preprocedure thrombolysis in myocardial infarction (TIMI) 0 flow (points = 2), and lesion length ≥35 mm (points = 3). In the validation set, the area under the curve the RK-SF/NR score was 0.775 (0.722 to 0.829) and a score ≥10 has sensitivity of 77.9% (68.2% to 85.8%), negative predictive value of 87.3% (82.3% to 91.0%), specificity of 62.6% (56.0% to 68.9%), and positive predictive value of 46.3% (41.4% to 51.2%). In conclusion, RK-SF/NR score had shown good discriminating power for predicting SF/NR during primary PCI with good sensitivity and negative predictive value. Hence, the proposed model can have good clinical utility for screening patients at high risk of developing SF/NR during primary PCI.
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Kumar R, Qamar N, Saghir T, Sial JA, Khan N, Karim M. TCTAP A-011 The Burden of Short-Term Major Adverse Cardiac Events and Its Determinants After Emergency Percutaneous Coronary Revascularization: A Prospective Follow-up Study. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Khan KA, Kumar R, Shah JA, Farooq F, Shaikh Q, Kumar D, Sial JA, Saghir T, Achakzai AS, Karim M. Comparison of angiographic results and clinical outcomes of no-reflow after stenting in left anterior descending (LAD) versus non-LAD culprit STEMI. SAGE Open Med 2022; 10:20503121221088106. [PMID: 35387152 PMCID: PMC8977700 DOI: 10.1177/20503121221088106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: No-reflow is a complication that frequently occurs after stenting during primary percutaneous coronary intervention. In this study, we focused on angiographic results and clinical outcomes after no-reflow in the left anterior descending (LAD) artery versus non–left anterior descending artery ST-elevation myocardial infarction (STEMI). Methods: In this prospective study, a total of 201 patients who had developed no-reflow during primary percutaneous coronary intervention were enrolled. The patients were divided into left anterior descending artery culprit and non-left anterior descending artery culprit groups. The primary endpoints were final thrombolysis in myocardial infarction flow, corrected thrombolysis in myocardial infarction frame count and final myocardial blush grade. Secondary endpoints were major adverse cardiovascular events in-hospital and at 1 month. Results: Out of the 201 patients, 60.19% had culprit left anterior descending artery. Pulse rate, baseline systolic and diastolic blood pressure, single-vessel disease, left ventricular ejection fraction <30%, baseline thrombolysis in myocardial infarction I flow and final thrombolysis in myocardial infarction II flow (24.8% vs 11.3%, p = .017), and thrombolysis in myocardial infarction frame count (28.17 ± 11.86 vs 24.38 ± 9.05, p = .016) were significantly higher in the left anterior descending artery group. In contrast, baseline Killip Class I, three-vessel disease, baseline thrombolysis in myocardial infarction II flow, final thrombolysis in myocardial infarction III flow (74.4% vs 87.5%, p = .024) and left ventricular ejection fraction >40% were significantly greater in the non–left anterior descending artery group. However, for both in-hospital and at 30 days, overall major adverse cardiovascular event was similar in the two groups. The demographics, clinical and medication profiles and the routes used to treat no-reflow were all comparable in both groups. Conclusions: No-reflow in left anterior descending artery ST-elevation myocardial infarction is associated with lower final thrombolysis in myocardial infarction III flow, higher thrombolysis in myocardial infarction frame count and relatively lower Grade III myocardial blush than non-left anterior descending artery ST-elevation myocardial infarction with subsequent lower left ventricular ejection fraction and a higher frequency of in-hospital heart failure and hospitalisation due to heart failure.
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Affiliation(s)
- Kamran Ahmed Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Rajesh Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jehangir Ali Shah
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Fawad Farooq
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Quratulain Shaikh
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Dileep Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Kumar R, Batra MK, Khowaja S, Ammar A, Kumar A, Shah JA, Sial JA, Saghir T, Karim M. CHA 2DS 2-VASc, a Simple Clinical Score Expanding Its Boundaries to Predict Contrast-Induced Acute Kidney Injury After Primary Percutaneous Coronary Interventions. Int J Nephrol Renovasc Dis 2022; 14:495-504. [PMID: 35002286 PMCID: PMC8725833 DOI: 10.2147/ijnrd.s347303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Promising results of CHA2DS2-VASc score have been reported for the prediction of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). However, data of its predictive strength in the context of primary PCI are not available. Therefore, in this study, we have assessed predictive value of CHA2DS2-VASc score for CI-AKI after primary PCI. Methods This analytical cross-sectional study was conducted between January 2021 and June 2021 at the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Inclusion criteria of the study was consecutive adult patients who had undergone primary PCI. Baseline CHA2DS2-VASc score was calculated, and either a 25% or 0.5 mg/dL increase in post-procedure serum creatinine level as compared to baseline level was categorized as CI-AKI. Results A total of 691 patients were included, of which 82.1% (567) were male. CI-AKI after primary PCI was observed in 63 (9.1%) patients, out of which 66.7% (42) of patients had CHA2DS2-VASc score of ≥2. The area under the curve (AUC) for the score was 0.725 [0.662 to 0.788] with a sensitivity and specificity of 66.7% [63.1% to 70.2%] and 66.7% [53.7% to 78.1%], respectively, at a cut-off value of ≥2. In multivariable analysis, left ventricular ejection fraction ≤30% and CHA2DS2-VASc ≥2 were found to be independent predictors with adjusted odds ratios of 2.19 [1.06–4.5] and 2.13 [1.13–4.01], respectively. Conclusion CHA2DS2-VASc score has a good predictive value for the prediction of CI-AKI after primary PCI. Criteria of CHA2DS2-VASc ≥2 can be used for the risk stratification of CI-AKI after primary PCI.
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Affiliation(s)
- Rajesh Kumar
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Mahesh Kumar Batra
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Sanam Khowaja
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Ali Ammar
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Ashok Kumar
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jehangir Ali Shah
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Tahir Saghir
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- Research Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Khan KA, Qamar N, Saghir T, Sial JA, Kumar D, Kumar R, Qayyum D, Yasin U, Jalbani J, Karim M. Comparison of Intracoronary Epinephrine and Adenosine for No-Reflow in Normotensive Patients With Acute Coronary Syndrome (COAR Trial). Circ Cardiovasc Interv 2022; 15:e011408. [PMID: 35000456 PMCID: PMC8843359 DOI: 10.1161/circinterventions.121.011408] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Intracoronary epinephrine has been effectively used in treating refractory no-reflow, but there is a dearth of data on its use as a first-line drug in normotensive patients in comparison to the widely used adenosine. Methods: In this open-labeled randomized clinical trial, 201 patients with no-reflow were randomized 1:1 into intracoronary epinephrine as the treatment group and intracoronary adenosine as the control group and followed for 1 month. The primary end points were improvement in coronary flow, as assessed by TIMI (Thrombolysis in Myocardial Infarction) flow, frame counts, and myocardial blush. Secondary end points were in-hospital and short-term mortality and major adverse cardiac events. Results: In all, 101 patients received intracoronary epinephrine and 100 patients received adenosine. Epinephrine was generally well tolerated with no immediate table death or ventricular fibrillation. No-reflow was more effectively improved with epinephrine with final TIMI III flow (90.1% versus 78%, P=0.019) and final corrected TIMI frame count (24±8.43 versus 26.63±9.22, P=0.036). However, no significant difference was observed in final grade III myocardial blush (55.4% versus 45%, P=0.139), mean reduction of corrected TIMI frame count (−25.71±11.79 versus −26.08±11.71, P=0.825), in-hospital and short-term mortality, and major adverse cardiac events. Conclusions: Epinephrine is relatively safe to use in no-reflow in normotensive patients. A significantly higher frequency of post-treatment TIMI III flow grade and lower final corrected TIMI frame count with relatively better achievement of myocardial blush grade III translate into it displaying relatively better efficacy than adenosine. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04699110.
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Affiliation(s)
- Kamran Ahmed Khan
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Nadeem Qamar
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Tahir Saghir
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Dileep Kumar
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Rajesh Kumar
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Danish Qayyum
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Umamah Yasin
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Javed Jalbani
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- Department of Clinical Research (M.K.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Batra MK, Malik MA, Khan KA, Rai L, Kumar R, Shah JA, Sial JA, Saghir T, Khan N, Karim M. Left Ventricular Functional Remodeling after Primary Percutaneous Coronary Intervention. J Cardiovasc Echogr 2022; 32:12-16. [PMID: 35669137 PMCID: PMC9164918 DOI: 10.4103/jcecho.jcecho_64_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/22/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Improvement in left ventricular (LV) function after revascularization is an important determinant of long-term prognosis in a patient with acute myocardial infarction (AMI). However, data on the changes of LV function after revascularization are scarce in our population. Hence, this study was conducted to evaluate the changes in LV function and dimensions by echocardiography at 3 and 6 months after primary percutaneous coronary intervention (PCI). MATERIALS AND METHODS A total of 188 patients were recruited in this study who had undergone primary PCI. Patients with preexistent LV dysfunction, prior PCI, or with congenital heart disease were excluded. Echocardiography was performed at baseline (within 24 h of intervention), 3 months, and 6 months of intervention. Remodeling in terms of change in LV ejection fraction (LVEF), LV end-diastolic dimension (LVEDD), LV end-systolic dimension, and wall motion score index (WMSI) was evaluated. RESULTS Out of the 188 patients, 90.4% were male, and mean age was 53.94 ± 9.12 years. Baseline mean LVEF was 39.79 ± 6.2% with mean improvement of 5.11 ± 3.87 (P < 0.001) at 3 months and 6.38 ± 4.29 (P < 0.001) at 6 months. Baseline LVEDD was 46.23 ± 3.86 mm which improved to 44.68 ± 2.81 mm at 6 months. Basal WMSI decreased by -0.09 ± 0.08 and -0.13 ± 0.09 at 3 and 6 months, respectively, after revascularization. CONCLUSIONS Primary PCI is the recommended mode of reperfusion in patients with AMI. It reduces infarct size, maintains microvascular integrity and preserves LV systolic function hence improving LV function.
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Affiliation(s)
- Mahesh Kumar Batra
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan,Address for correspondence: Dr. Mahesh Kumar Batra, National Institute of Cardiovascular Diseases, Rafiqui (H.J.) Shaheed Road, Karachi 75510, Pakistan. E-mail:
| | - Muhammad Atif Malik
- Department of Cardiology, Al Mana General Hospital, Eastern Region, Hofuf, Saudi Arabia
| | - Kamran Ahmed Khan
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Lajpat Rai
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Rajesh Kumar
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Jehangir Ali Shah
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Jawaid Akbar Sial
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Tahir Saghir
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Naveedullah Khan
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Musa Karim
- Department of Clinical Research, National Institute of Cardiovascular Diseases, Karachi, Pakistan
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Kumar R, Ahmed Khan K, Rai L, Ahmed Solangi B, Ammar A, Nauman Khan M, Ahmed I, Ahmed B, Saghir T, Akbar Sial J, Karim M. Comparative analysis of four established risk scores for predicting contrast induced acute kidney injury after primary percutaneous coronary interventions. Int J Cardiol Heart Vasc 2021; 37:100905. [PMID: 34765719 PMCID: PMC8569474 DOI: 10.1016/j.ijcha.2021.100905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022]
Abstract
Objectives This study aimed to compare Mehran Risk Score (MRS) with three well -known scoring systems namely CHA2DS2-VASc score, Canada Acute Coronary Syndrome Risk Score (C-ACS), and Thrombolysis in Myocardial Infarction risk index (TRI) to predict the contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention (PCI). Background CI-AKI is a common complication after primary PCI associated with an adverse prognosis. Methods In this study consecutive patients of primary PCI were included. Patients with chronic kidney diseases, exposure to the contrast medium within the past 7 days, and Killip class IV at presentation were excluded. MRS along with three risk scores namely CHA2DS2-VASc, C-ACS, and TRI were calculated for all patients and CI-AKI was defined as either 0.5 mg/dL or 25% relative increase in post-procedure serum creatinine. The area under the curve (AUC) curve was reported. Results Post primary PCI CI-AKI was observed in 63 (9.1%) patients out of 691 patients. The AUC was 0.745 [0.679-0.810] for MRS, 0.725 [0.662-0.788] for CHA2DS2-VASc, 0.671 [0.593-0.749] for C-ACS, and 0.734 [0.674-0.795] for TRI. Sensitivity and specificity were 61.9% [48.8-73.8%] and 76.0% [72.4-79.3%] for MRS ≥ 6.5, 66.7% [53.7-78.0%] and 66.7% [62.9-70.4%] for CHA2DS2-VASc ≥ 2, 52.4% [39.4-65.1%] and 79.9% [76.6-83.0%] for C-ACS ≥ 1, and 87.3% [76.5-94.4%] and 49.2% [45.2-53.2%] for TRI ≥ 16 respectively. Conclusions The MRS has shown higher discriminating power than CHA2DS2-VASc, C-ACS, and TRI. However, the TRI can be of good value in clinical practice due to its simplicity and high sensitivity in detecting patients at higher risk of CI-AKI after primary PCI.
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Affiliation(s)
- Rajesh Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Kamran Ahmed Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Lajpat Rai
- National Institute of Cardiovascular Diseases (NICVD), Hyderabad, Pakistan
| | | | - Ali Ammar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Ifikhar Ahmed
- National Institute of Cardiovascular Diseases (NICVD), Hyderabad, Pakistan
| | - Bilal Ahmed
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Kumar D, Saghir T, Kumar R, Sial JA, Khan KA, Shah JA, Karim M, Mueed A, Bai R, Kumar H, Ali S, Kumari R. Predictors of 6-month Mortality in Patients with Non-ST Elevation Acute Coronary Syndrome: A Study in Pakistani Population. J Saudi Heart Assoc 2021; 33:286-292. [PMID: 35083118 PMCID: PMC8754448 DOI: 10.37616/2212-5043.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives For Southern Asian countries like Pakistan, there is inadequate evidence of risk factors associated with mortality in patients suffering from acute coronary syndrome (ACS), especially non-ST elevation ACS (NSTE-ACS) cases. Therefore, aim of this study was to evaluate predictors of 6-months mortality of patients presenting with NSTE-ACS. Methods For this prospective observational study we recruited adult patients diagnosed with NSTE-ACS at a tertiary cardiac center. All he patients were followed-up after six months and survival status was recorded. Logistic regression analysis was performed for six-month mortality and odds ratio (OR) and 95% confidence interval (CI) were reported. Results Six-month follow-up was successful for 280 patients. On univariate analysis age >65 years, increased heart rate, cardiac arrest at presentation, Killip class II–IV at presentation, and diabetes were found to be associated with increased risk of 6-months mortality with OR [95% CI] of 4.27 [1.9–9.58], 1.25 [1.1–1.41], 139.44 [16.9–1150.78], 68.45 [7.88–594.41], and 2.35 [1.06–5.22] respectively. On multivariable analysis Killip class II–IV at presentation, thrombolysis in myocardial infarction (TIMI) score of >4, and global registry of acute coronary events (GRACE) score ≥150 were found to be independent predictors of mortality after six months of NSTE-ACS with adjusted OR of 32.93 [2.65–408.8], 3.42 [1.35–8.66], and 8.43 [3.33–21.38] respectively. Conclusions For patients with NSTE-ACS, our study showed seven clinical parameters to be associated with an increased risk of 6-month mortality. These included increasing age, increased heart rate, cardiac arrest at presentation, Killip class II–IV, diabetes, TIMI score of >4 and GRACE score of >150. Thereby aiding clinicians to apply strategic and precise interventions in monitoring these patients accordingly.
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Affiliation(s)
- Dileep Kumar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi,
Pakistan
- Corresponding author. E-mail address: (D. Kumar)
| | - Tahir Saghir
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi,
Pakistan
| | - Rajesh Kumar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi,
Pakistan
| | - Jawaid Akbar Sial
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi,
Pakistan
| | - Kamran Ahmed Khan
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi,
Pakistan
| | - Jehangir Ali Shah
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi,
Pakistan
| | - Musa Karim
- Department of Research, National Institute of Cardiovascular Diseases, Karachi,
Pakistan
| | - Abdul Mueed
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi,
Pakistan
| | - Reeta Bai
- Department of Radiology, Dow University of Health Sciences, Karachi,
Pakistan
| | - Hitesh Kumar
- Department of Medicine, Government of Sindh, Karachi,
Pakistan
| | - Sajjad Ali
- Department of Medicine, Ziauddin Medical University, Karachi,
Pakistan
| | - Rekha Kumari
- Department of Medicine, Government of Sindh, Karachi,
Pakistan
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Kumar D, Saghir T, Sial JA, Kumar R, Karim M, Huma ZE, Qamar N. USE OF EXPORT VS. BALLOON IN PRIMARY PERCUTANEOUS CORONARY INTERVENTION, IN-HOSPITAL OUTCOMES AND OPTIMAL EXPORT TIME. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kumar R, Tariq S, Fatima M, Saghir T, Batra MK, Karim M, Sial JA, Khan N, Rizvi SNH. Validity of the Stent Thrombosis Risk Score in Predicting Early Stent Thrombosis after Primary Percutaneous Coronary Intervention. J Saudi Heart Assoc 2020; 32:256-262. [PMID: 33154926 PMCID: PMC7640563 DOI: 10.37616/2212-5043.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/11/2019] [Accepted: 12/24/2019] [Indexed: 11/20/2022] Open
Abstract
Background The thrombosis of the stent is one of the most important complications of percutaneous interventions, resulting in complete occlusion of the stented vessel. Aim of this study was to determine the validity of Stent Thrombosis Risk Score (STRS) in predicting early stent thrombosis (ST) after primary Percutaneous Coronary Intervention (PCI). Methods For this study, 569 consecutive patients undergone primary PCI from July 2018 to December 2018 were recruited. Early ST was defined as ST occurred during or within 30 days after the procedure. The STRS was calculated as proposed, developed, and validated in a past study. The receiver operating characteristic curve analysis was performed to determine the optimal cut-off value and area under the curve (AUC). Results A total of 569 patients were included, the median age was 56 [61-50] years. Early ST was observed in 33 (5.8%) patients. The median STRS was 4 [5-3] vs. 3 [4-2]; p = 0.009 for patients with and without Early ST respectively. STRS was found to be an independent predictor of early ST with an adjusted odds ratio of 1.41 (1.02-1.95). AUC was 0.631 and the optimal cut-off value was ≥5. Early ST rate was 3.3% at STRS of 0-2, which raised to 5.0% at STR of 3-4, and 17.2% at STRS of ≥5. Conclusions In conclusion, STRS was found to be an independent predictor of early ST after primary PCI and has significant discriminating power. The rate of early stent thrombosis after primary PCI exponentially increased at STRS cut-off value of ≥5.
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Affiliation(s)
- Rajesh Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Sahar Tariq
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Madiha Fatima
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Mahesh Kumar Batra
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Naveedullah Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Abstract
Background and Objective Depression and anxiety are very common in patients with cardiac diseases. Percutaneous coronary intervention (PCI) has not only decreased mortality but angina, heart failure and recurrent hospitalization all are improved. Therefore, anxiety and depression associated with fibrinolytic therapy in acute coronary syndrome (ACS) are expected to be decreased in the patient undergoing PCI. Therefore, the aim of this study was to determine prevalence of depression and anxiety in patients undergoing percutaneous coronary intervention for acute coronary syndrome. Methods This study was conducted at Larkana Satellite Center of National Institute of Cardiovascular Diseases (NICVD), Pakistan from August 2018 to December 2018. Patients who underwent cardiac intervention within one month were enrolled in this study. Patients were interviewed regarding their basic demographics, indication for intervention and procedure details. Symptoms of anxiety were assessed using the translation of inventory of SAS (Zung's Self-Rating Anxiety Scale). Patients were interviewed for depression by using Becks depression inventory (BDI). Results A total of 153 patients were included in this study out of which 118 (77.1%) were males and 35 (22.5%) were females. All were married except one. Diabetes mellitus (DM) was present in 61 (39.9%), hypertension (HTN) in 69 (45.15%), obesity in 15 (9.8%), and 40 (26.1%) were smokers. Depression was present in 16 (10.5%) patients and anxiety was present in 12 (7.5%) of patients. On analysis of the association of various factor with depression; non-diabetics, housewives, laborers and uneducated were found to be more depressed. While those who smoke or earn more than 50 thousand were found less likely to be depressed. Conclusion Both depression and anxiety were present in only 10.5% and 7.5% of the patients after percutaneous coronary intervention for acute coronary syndrome.
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Affiliation(s)
- Syed Fayaz Mujtaba
- Syed Fayaz Mujtaba, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Jawaid Akbar Sial
- Jawaid Akbar Sial, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Musa Karim
- Musa Karim, National Institute of Cardiovascular Diseases, Karachi, Pakistan
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Muhammad AS, Ashraf T, Mir A, Alishan S, Farooq F, Ammar A, Karim M, Rizvi SNH, Saghir T, Sial JA, Khan NU. Comparative assessment of clinical profile and outcomes after primary percutaneous coronary intervention in young patients with single vs multivessel disease. World J Cardiol 2020; 12:136-143. [PMID: 32431784 PMCID: PMC7215964 DOI: 10.4330/wjc.v12.i4.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/10/2019] [Accepted: 03/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Even though percutaneous coronary intervention (PCI) improved the survival of patients with acute myocardial infarction, still multivessel coronary artery disease remains an important factor burdening prognosis and it is being associated with a worse prognosis compared to single-vessel disease (SVD).
AIM To compare the clinical profile and outcomes after the primary PCI in young patients with SVD vs multivessel disease (MVD).
METHODS The retrospective cohort of patients were divided into two groups: SVD and MVD group. The study population consisted of both male and female young (≤ 45 years) patients presented with ST-elevation myocardial infarction (STEMI) at the National Institute of Cardiovascular Disease, Karachi, Pakistan and undergone primary PCI from 1st July 2017 to 31st March 2018. Pre and post-procedure management of the patients was as per the guidelines and institutional protocols.
RESULTS A total of 571 patients with STEMI, ≤ 45 years were stratified into two groups by the number of vessels involved, 342 (59.9%) with SVD and 229 (40.1%) with MVD. The average age of these patients was 39.04 ± 4.86 years. A lower prevalence of hypertension and diabetes was observed in SVD as compare to MVD group (25.1% vs 38%, P < 0.01; 11.7% vs 27.5%, P < 0.001) respectively. While, smoking was more prevalent among the SVD group as compare to MVD group (36.3% vs 28.4%, P = 0.05). The high-C Lesion was observed in a significantly higher number of younger patients with MVD as compared to SVD group (48.8% vs 39.2%, P = 0.021). Post-procedure thrombolysis in myocardial infarction flow grade was found to be not associated with the number of diseased vessels with a P value of 0.426 and thrombolysis in myocardial infarction flow grade III was observed in 98% vs 96.5% of the patients is SVD vs MVD group.
CONCLUSION The MVD comprised of around 40% of the young patients presented with STEMI. Also, this study shows that diabetes and hypertension have a certain role in the pathogenesis of multivessel diseases, therefore, preventive measures for diabetes and hypertension can be effective strategies in reducing the burden of premature STEMI.
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Affiliation(s)
- Atif Sher Muhammad
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Tariq Ashraf
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Ayaz Mir
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Syed Alishan
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Faiza Farooq
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Ali Ammar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Musa Karim
- Department of Clinical Research, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Syed Nadeem Hassan Rizvi
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Tahir Saghir
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Jawaid Akbar Sial
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Naveed Ullah Khan
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
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Batra MK, Rizvi NH, Sial JA, Saghir T, Karim M. Angiographic characteristics and in hospital outcome of young patients, age up to 40 versus more than 40 years undergoing primary percutaneous coronary intervention. J PAK MED ASSOC 2019; 69:1308-1312. [PMID: 31511716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare angiographic characteristics and outcomes of primary percutaneous coronary intervention between young and old patients presenting with acute ST Elevation Myocardial Infarction. METHODS The prospective observational study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from December 17, 2016, to June 16, 2017, and comprised acute ST-Elevation Myocardial Infarction patients undergoing primary percutaneous coronary intervention (PCI). Data was collected on demographic, angiographic, and in-hospital outcomes. Those <40 years were considered young. Data was analysed using SPSS 21. RESULTS Of the 415 patients, 50(12%) were young. Proportion of male was higher among the young (p=0.02) and so was the case with positive family history (p=0.002). The young had lesser cases of diabetes (p=0.028) and hypertension (p=0.034). Single vessel disease was more common among young (p<0.001). No significant difference was observed in post-procedure outcome related to age (p>0.05). CONCLUSIONS Acute Myocardial Infarction in young was more likely associated with male gender, positive family history and less likely with hypertensive and diabetic status.
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Affiliation(s)
| | | | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD) Karachi, Pakistan
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD) Karachi, Pakistan
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD) Karachi, Pakistan
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Abstract
Background & Objective Due to increase in number of cardiac catheterization procedures safety concerns is an issue nowadays. Multiple diagnostic modalities use radiations, which also put a patient at higher cumulative radiation exposure. Therefore steps should be taken to minimize radiation exposure during cardiac catheterization. Hence determination of factors which prolong FT will result in better understanding of problem. This retrospective study was undertaken to determine factors responsible for prolong fluoroscopy time in patients undergoing coronary artery catheterization. Methods This retrospective study was conducted at catheterization Laboratory National Institute of Cardiovascular Diseases, Karachi from June 2014 to June 2015. Patients of either gender, aged between 18 to 90 years undergoing cardiac catheterization procedures were included. Radiation exposure time was measured in terms of fluoroscopy time. Results A total of 957 patients were included in this study out of which 731 were of diagnostic Coronary Angiograms (CA) and 226 were of Percutaneous Coronary Intervention (PCI). The mean age of the study participants was 54.12±10.89 years and majority 734(76.6%) were male. Mean fluoroscopy time (FT) in the patients subjected to PCI was 9.61±6.07 minutes while in cases for CA 4.17±4.13 minutes. FT for CA was observed significantly dependent on procedural access, operator's experience, and LV angiogram. While FT for PCI was found dependent on number of stents deployed during the procedure. Conclusion For invasive coronary angiographic procedures radial route increased fluoroscopy time. For percutaneous coronary intervention femoral and radial route fluoroscopy time were not significantly different.
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Affiliation(s)
- Syed Fayaz Mujtaba
- Syed Fayaz Mujtaba, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Tahir Saghir
- Tahir Saghir, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Jawaid Akbar Sial
- Jawaid Akbar Sial, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Nadeem Hassan Rizvi
- Nadeem Hassan Rizvi National Institute of Cardiovascular Diseases, Karachi, Pakistan
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Kalwar MH, Sial JA, Saghir T, Rizvi NH, Qamar N. Managed successfully: Iatrogenic aortic dissection during primary percutaneous coronary intervention. J PAK MED ASSOC 2018; 68:660-662. [PMID: 29808063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Iatrogenic aortic dissection caused by primary percutaneous coronary intervention (PCI) is a rare but potentially fatal complication; therefore prompt recognition of this life-threatening condition is crucial. We present herein a case of a 70-year-old lady who underwent primary PCI for transmural myocardial infarction of left anterior descending artery territory. Manipulation of the extra backup (EBU) guiding catheter during an attempt to cannulate the left system resulted in an aortic dissection. The patient was managed conservatively with strict monitoring in the coronary care unit (CCU), and underwent serial evaluation with non-invasive imaging studies including a computed tomography angiography (CTA). On the 3rd post-procedure day, she developed cerebrovascular accident from which she recovered completely. Repeat CT angiogram showed complete resolution of the ascending aortic dissection. Initial follow-up was conducted at 2 weeks and the patient was doing well.
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Affiliation(s)
| | | | - Tahir Saghir
- National Institute of Cardiovascular Disease Karachi Pakistan
| | | | - Nadeem Qamar
- National Institute of Cardiovascular Disease Karachi Pakistan
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Shah GA, Sial JA, Saghir T. Complete Heart Block due to Occlusion of Jailed Septal Perforator after Percutaneous Coronay Intervention of Proximal Left Anterior Descending Artery. J Coll Physicians Surg Pak 2018; 28:S7-S8. [PMID: 29482688 DOI: 10.29271/jcpsp.2018.03.s7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 10/26/2017] [Indexed: 11/11/2022]
Abstract
A 70-year diabetic and hypertensive lady admitted with acute coronary syndrome (ACS) underwent coronary angiography, which showed severe diffuse disease of proximal left anterior descending (LAD). She underwent percutaneous coronay intervention (PCI) of proximal LAD artery that resulted in occlusion of jailed first septal perforator. She remained stable and asymptomatic and was shifted to Coronary Care Unit (CCU) after successful procedure. Approximately five hours later, patient developed complete heart block (CHB) and became hemodynamically unstable. Temporary pacemaker (TPM) was implanted and relook angiogram was performed, which showed patent stent. Patient remained dependent on TPM. After one week, permanent pacemaker was implanted and patient discharged in stable condition.
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Affiliation(s)
- Ghazanfar Ali Shah
- Department of Cath Lab, National Institute of Cardiovascular Diseases (NICVD), Karachi
| | - Jawaid Akbar Sial
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi
| | - Tahir Saghir
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi
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Farman MT, Khan N, Sial JA, Saghir T, Ashraf T, Rasool SI, Zaman KS. Predictors of successful percutaneous transvenous mitral commissurotomy using the Bonhoeffer Multi-Track system in patients with moderate to severe mitral stenosis: Can we see beyond the Wilkins score? Anatol J Cardiol 2014; 15:373-9. [PMID: 25430403 PMCID: PMC5779173 DOI: 10.5152/akd.2014.5466] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To know the predictors of a successful outcome of percutaneous transvenous mitral commissurotomy (PTMC) other than described in the Wilkins scoring system. Methods Two hundred fifty-eight consecutive patients were enrolled for this observational study in a tertiary care heart center of Pakistan who had a Wilkins score of ≤8. Patients with more than mild mitral regurgitation (MR) or having a clot in the left atrium were excluded. The Bonhoeffer multi-track system was used as a default technique. Successful PTMC was defined as achieving a mitral valve area (MVA) of ≥1.5 cm2 with no more than mild MR. Results Out of 258 PTMC procedures, 197 were successful. The Bonhoeffer multi-track system was used in ~94% cases. Among unsuccessful procedures, 41 patients did not achieve the required valve area, and 21 patients developed more than mild MR, including those 8 patients who did not achieve the required valve area and had more than mild MR. Bigger mean annulus size (33.5±2.6 versus 32.8±2.1 mm; p=0.02) and pre-procedure MVA (0.93±0.1 versus 0.87±0.1 cm2; p=0.002) had a significant effect on successful PTMC. Lower mean preprocedure systolic right ventricular pressure on echo (65.4±19.4 versus 75.3±18 mm Hg; p=0.000) and on cath (74±21.5 versus 81.5±24.6 mm Hg; p=0.002), lower grade of left ventricular dysfunction (p=0.04), and tricuspid regurgitation on echo (p=0.003) also had positive effects on the outcome. Conclusion Bigger preprocedure mitral valve annulus size and mitral valve area, and better left and right ventricular hemodynamics are correlated with successful PTMC.
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Farman MT, Saghir T, Rizvi NH, Sial JA, Khan N, Malik A, Zaman KS. Safety of primary percutaneous coronary intervention with and without (selective) thrombus aspiration. J PAK MED ASSOC 2014; 64:653-659. [PMID: 25252484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the safety and efficacy of selective thrombus aspiration during Primary Percutaneous Coronary Intervention (PCI). METHODS This observational prospective study was conducted in the catheterization laboratory of a tertiary care cardiovascular centre. A total of 150 consecutive patients who underwent primary PCI were enrolled. Aspiration was done only when thrombus burden was considered significant. After completion of procedure angiographic and electrocardiographic signs were recorded and clinical follow up was documented up to 1 year. RESULTS No significant difference among the groups was found in age, height, weight and other risk factors like Hypertension, Diabetes Mellitus and Smoking. In general, left anterior descending artery was culprit in - 65% of patients and more than 90% of culprit vessels had visible thrombus. Multivessel disease was present in 38% of patients and 22.7% had past history of myocardial infarction. Out of 150 patients 117 (78%) underwent thrombus aspiration. No significant difference was found in ST resolution within 60 minutes (72.6 vs 81.8%; P < 0.285) and myocardial blush grade II & III (41.9 vs 27.3%; P < 0.128). No difference in event free survival was observed among the two groups (80.3 vs 84.8%; P < 0.708) at one year. CONCLUSION Selective thrombus aspiration in definite thrombus laden arteries and no aspiration in low or negligible thrombus burden vessels may be a safe and effective strategy in patients undergoing primary PCI. Overall poor risk profile of our patients as compared to western population necessitates further evaluation of this matter in randomized studies.
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Farman MT, Sial JA, Khan NU, Rizvi SNH, Saghir T, Zaman KS. Outcome of primary percutaneous coronary intervention at public sector tertiary care hospital in Pakistan. J PAK MED ASSOC 2011; 61:575-581. [PMID: 22204214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To determine the outcome of Primary Precutaneous Coronary Intervention (PCI) in our setup and compare the results with the west. METHODS This study was conducted at a tertiary care teaching Hospital (National Institute of Cardiovascular Diseases Karachi, Pakistan) during January 1st, 2008 to December 31st, 2008. A total of 113 patients were enrolled who came with STEMI and agreed to go for Primary PCI. We excluded the patients who had history of Thrombolytic therapy within 24 hours, presented with Non ST-elevation Myocardial Infarction (NSTEMI) and coronary angiogram revealed significant left Main or equivalent disease. All Patients received Aspirin, Clopidogrel and Platelet Glycoprotein IIB IIIA Inhibitor. After Primary PCI patients were planned to follow at one month, 3 months and 6 months. Primary end point was to document death, MI, CABG and rehospitalization. RESULTS Out of 113 cases, 102 (90.3%) were male and 11 (9.7%) were female, Mean age was 51.2 +/- 11.7 years, 54 (47.8%) patients had Hypertension, 28 (24.8%) were Diabetics and 44 (38.9%) were Smokers. Immediate success was achieved in 111 (98.2%) cases. In hospital mortality was 5.3% (3.5% in cardiogenic shock, 1.7% in non-shock patients). Mean Door to Balloon time remained 98.4 minutes. Twelve patients were lost to follow up. Therefore at 6 months, out of 101 patients, 8 (7.9%) died, 5 (4.9%) underwent Coronary Artery Bypass Graft (CABG) surgery and 5 (4.9 %) had been re-hospitalized either for recurrent myocardial infarction or heart failure. CONCLUSION Optimal results of primary percutaneous coronary intervention can be achieved for acute STEMI in a developing country at a tertiary care public sector hospital. The results are comparable and nearly similar to the west.
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Farman MT, Sial JA, Khan NU, Masood T, Saghir T. Undefeatable coronary lesion. J PAK MED ASSOC 2011; 61:185-187. [PMID: 21375175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We report a case in which a calcification in mid left anterior descending (LAD) artery was not apparent initially on angiogram and stenting was done after inappropriate predilation resulting in underexpansion of stent. High pressure inflation, buddy wire technique, scoring and cutting balloon inflation failed to achieve the full expansion of stent.
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Sial JA, Farman MT, Saghir T, Zaman KS. Percutaneous transvenous mitral commissurotomy (PTMC) and percutaneous coronary intervention (PCI) successfully applied in one patient in same sitting. J PAK MED ASSOC 2011; 61:90-92. [PMID: 22368914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Sixty years old male with severe rheumatic mitral stenosis (MS), presented with dyspnoea New York Heart Association (NHYA) class III to IV. Coronary angiogram revealed severe occlusive coronary artery disease in left anterior coronary artery (LAD). Percutaneous Transvenous Mitral Commissurotomy (PTMC) and Percutaneous Coronary Intervention (PCI) of Left Anterior Descurery (LAD) were done in same sitting. Both procedures were successful and ended without complication. After, half an hour while shifting to coronary care unit (CCU) patient developed cardiac tamponade, which was managed successfully. Patient was followed up for three month, he is doing well and recent echocardiogram showed mild mitral stenosis with normal left ventricular function. This case demonstrates the feasibility of the combined appliance on interventional techniques in selected patients as an alternative to cardiac surgery.
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Affiliation(s)
- Jawaid Akbar Sial
- Department of Cardiology, Chandka Medical College, Larkana, Sindh, Karachi
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Farman MT, Sial JA, Khan N, Rahu QA, Tasneem H, Ishaq M. Severe mitral stenosis with atrial fibrillation--a harbinger of thromboembolism. J PAK MED ASSOC 2010; 60:439-443. [PMID: 20527639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To determine the frequency of Left Atrial thrombus in patients suffering from severe mitral stenosis with atrial fibrillation. METHODS A cross sectional descriptive type study was conducted in the Echocardiography department of the National Institute of Cardio Vascular Diseases (NICVD) Karachi from October 1, 2007 to March 17, 2008. A total of 100 consecutive adult patients with severe Mitral stenosis (MS) and Atrial Fibrillation (AF) were included in this study. 12-lead Electrocardiography was done once clinical and echocardiographic features revealed Sever MS. Patients with signs of AF were selected and Transthoracic Echocardiography (TTE) was obtained to detect Left Atrial Thrombus. Transesophageal echocardiography (TEE) was performed whenever thrombus could not be found with TTE and / or nature of the mass could not be confirmed. RESULTS Among 100 patients studied; there were 52 males and 48 females. TTE was performed in all patients and LA thrombi were detected in 24% patients. TEE was performed in remaining 76% patients and additional 14 patients with LA thrombi were detected in this subgroup. Therefore a total of 38% of the patients with LA thrombi were documented. Among them, 6% had clots in LA body while LA appendage clots were found in 32% of patients. Left atrial dimension was found to be relevant (P-value = 0.004) with the presence of thrombus in patients with severe mitral stenosis associated with atrial fibrillation. Left atrial spontaneous echo contrast (LASEC) was found in 54% of patients but it was not found to be relevant with the presence of LA thrombus (P = 0.75). CONCLUSION Left atrial thrombus was present in 38% patients with severe mitral stenosis associated with atrial fibrillation. Larger left atrial diameter is a stronger predictor of presence of LA thrombus
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Farman MT, Sial JA, Saghir T, Rizvi SNH, Rasool SI, Jamal SZ. Successful management of dislodged stents during percutaneous coronary intervention. J PAK MED ASSOC 2010; 60:140-142. [PMID: 20209706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Stent dislodgement is a very rare but recognized and potentially serious complication of percutaneous coronary intervention (PCI). This case series describe the incidence and etiology of such cases at National Institute of Cardiovascular Diseases, Karachi during the year 2008 and the method of treatment of this complication.
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Khan NU, Farman MT, Sial JA, Achakzai AS, Saghir T, Ishaq M. Changing trends of infective endocarditis. J PAK MED ASSOC 2010; 60:24-27. [PMID: 20055275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To determine the frequency of culture positive and culture negative endocarditis and type of organisms causing bacterial endocarditis in patients admitted at National Institute of Cardiovascular Diseases (NICVD), Karachi. METHODS This was a cross sectional, descriptive study conducted from 29th March 2006 to 13th October 2006 at National Institute of Cardiovascular Diseases, Karachi. All patients having clinical suspicion of infective endocarditis were admitted and worked up. Seventy five patients having definite infective endocarditis as per Duke Criteria were included. RESULTS There were 55 (70%) males and 20 (30%) females. Mean age of the patients was 23 +/- 8.9 years. Ninety percent of the patients were below 40 years of age. Six patients had prosthetic valve and six were intravenous drug abusers. The commonest signs and symptoms observed were fever, shortness of breath, weight loss, murmur, pallor and splenomegaly. Mitral valve was affected in majority of patients. Blood cultures were positive in 40 (53.3%) cases while 35 (46.7%) cases were culture negative. Nine (22.5%) patients out of 40 culture positive cases and 29 (82.8%) patients out of 35 culture negative cases were using antibiotics before admission. All six intravenous drug abusers showed culture positive endocarditis. Among culture positive cases, staphylococcus group was found in 21 (52.5%) cases while streptococcus group in 11 (27.5%) cases. Coagulase negative staphylococci were found to be the most common organism, that is 14/40 (35%) patients. CONCLUSION Changes in spectrum of organisms causing bacterial endocarditis reported by western researchers do exist in our community. To know the reason behind these changing trends needs further advanced studies and evaluation.
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Sial JA, Ferman MT, Saghir T, Rasool SI. Coronary embolism causing acute myocardial infarction in a patient with mitral valve prosthesis: successful management with angioplasty. J PAK MED ASSOC 2009; 59:409-411. [PMID: 19534381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A 24-year-old male patient with anterior myocardial infarction, caused by embolization from mitral valve prosthesis due to inadequate anticoagulation is presented. The patient underwent cardiac catheterization within 90 minutes of arrival. Angiography showed total occlusion of the left anterior descending coronary artery (LAD) after the second diagonal branch. Thrombus was extracted with export catheter from LAD, and coronary artery perfusion was restored. The pain disappeared completely immediately after this intervention. Transoesophageal echocardiography performed 2 days later revealed no thrombus at the prosthetic valve. In conclusion, this case demonstrated that coronary embolism may occur even without prosthetic valve thrombus or dysfunction with suboptimal International Normalized Ratio levels, and can be successfully treated with coronary angiography with clot extraction with aspiration catheter (Export XT 6F Medtronic) only, without stenting.
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