Objective: To evaluate role of rajyoga meditation (RYM) versus stress management counselling (SMC) in addressing burnout syndrome and resultant improvement in electrocardiogram (ECG) so as to automate burnout prediction from raw ECG data with machine learning (ML).
Methods: Healthcare providers were assigned to two groups: RYM (n=100) or SMC (n=102). Subjects in RYM received rajyoga for 3 months including one week offline and thereafter, virtual mode. SMC group received counselling for 1 day in offline mode and thereafter, received positive thoughts on a weekly basis. All subjects were assessed for psychological (depression, anxiety, stress scale-21 (DASS-21) and burnout syndrome (Mini Z questionnaire) along with 12-lead ECG at baseline after 4 weeks, and after 12 weeks. Based on response on question 3 of the Mini-Z questionnaire, participants were classified either as burnout or satisfied.
Results: RYM group showed significant reduction in depression, anxiety, and stress in comparison to SMC group. Burnout results display significant reduction in the RYM group in comparison to SMC group. Reduction in burnout and enhancement in satisfaction from visit-1 to visit-3: burnout visit-1 (27.2%), visit-2 (23.8%), visit-3 (19.3%) and, satisfaction visit-1 (72.8%), visit-2 (76.2%), and visit-3 (80.7%). ML algorithms could identify burnout patients using the raw ECG data with time-series features based classifier performing better than Ultra Short HRV features based ML classifier model.
Conclusion: AI based early diagnosis of heart's healthy status using ECG analysis may prevent development of cardiovascular disorder in the long run.
{"title":"Psychological problems and burnout among healthcare workers: impact of non-pharmacological lifestyle interventions.","authors":"Mohit Dayal Gupta, Shekhar Kunal, Girish Mp, Ekta Chalageri, Deepak Kumar, Vivek Singh, Ankit Bansal, Vishal Batra, Jamal Yusuf, Reena Tomar, Akshita Gupta, Anubha Gupta","doi":"10.1016/j.ihj.2024.11.245","DOIUrl":"https://doi.org/10.1016/j.ihj.2024.11.245","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate role of rajyoga meditation (RYM) versus stress management counselling (SMC) in addressing burnout syndrome and resultant improvement in electrocardiogram (ECG) so as to automate burnout prediction from raw ECG data with machine learning (ML).</p><p><strong>Methods: </strong>Healthcare providers were assigned to two groups: RYM (n=100) or SMC (n=102). Subjects in RYM received rajyoga for 3 months including one week offline and thereafter, virtual mode. SMC group received counselling for 1 day in offline mode and thereafter, received positive thoughts on a weekly basis. All subjects were assessed for psychological (depression, anxiety, stress scale-21 (DASS-21) and burnout syndrome (Mini Z questionnaire) along with 12-lead ECG at baseline after 4 weeks, and after 12 weeks. Based on response on question 3 of the Mini-Z questionnaire, participants were classified either as burnout or satisfied.</p><p><strong>Results: </strong>RYM group showed significant reduction in depression, anxiety, and stress in comparison to SMC group. Burnout results display significant reduction in the RYM group in comparison to SMC group. Reduction in burnout and enhancement in satisfaction from visit-1 to visit-3: burnout visit-1 (27.2%), visit-2 (23.8%), visit-3 (19.3%) and, satisfaction visit-1 (72.8%), visit-2 (76.2%), and visit-3 (80.7%). ML algorithms could identify burnout patients using the raw ECG data with time-series features based classifier performing better than Ultra Short HRV features based ML classifier model.</p><p><strong>Conclusion: </strong>AI based early diagnosis of heart's healthy status using ECG analysis may prevent development of cardiovascular disorder in the long run.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/j.ihj.2024.11.244
Manish Bansal, Ravi R Kasliwal, Praveen Chandra, Rajneesh Kapoor, Nagendra Chouhan, Anil Bhan, Naresh Trehan
This study aimed to assess the effectiveness of current lipid-lowering therapy in achieving low-density lipoprotein cholesterol (LDL-C) goals in Indian patients undergoing coronary revascularization. Consecutive subjects (n= 1275, mean age 60.0±9.7 years, 87.2% men) with newly diagnosed coronary artery disease and undergoing coronary revascularization during the period 1 Jan 2023 to 31 Dec 2023 were included. After a median follow-up of 99 days (interquartile range 91-109 days), the mean LDL-C was 63.9±24.3 mg/dL with 67.5% and 29.9% of subjects having LDL-C <70 mg/dL and <50 mg/dL, respectively. These proportions were 70.8% and 32.1% for patients treated with high-intensity statin therapy (rosuvastatin 20-40 mg/d or atorvastatin 40-80 mg/d). Among patients treated with rosuvastatin 40 mg/d and ezetimibe 10 mg/d, 53.3% achieved LDL-C <50 mg/dL. These findings underscore the need for greater usage of combination lipid-lowering therapy and agents with high LDL-C lowering efficacy.
{"title":"Attainment of low-density lipoprotein cholesterol goals in patients undergoing coronary revascularization in the contemporary clinical practice.","authors":"Manish Bansal, Ravi R Kasliwal, Praveen Chandra, Rajneesh Kapoor, Nagendra Chouhan, Anil Bhan, Naresh Trehan","doi":"10.1016/j.ihj.2024.11.244","DOIUrl":"https://doi.org/10.1016/j.ihj.2024.11.244","url":null,"abstract":"<p><p>This study aimed to assess the effectiveness of current lipid-lowering therapy in achieving low-density lipoprotein cholesterol (LDL-C) goals in Indian patients undergoing coronary revascularization. Consecutive subjects (n= 1275, mean age 60.0±9.7 years, 87.2% men) with newly diagnosed coronary artery disease and undergoing coronary revascularization during the period 1 Jan 2023 to 31 Dec 2023 were included. After a median follow-up of 99 days (interquartile range 91-109 days), the mean LDL-C was 63.9±24.3 mg/dL with 67.5% and 29.9% of subjects having LDL-C <70 mg/dL and <50 mg/dL, respectively. These proportions were 70.8% and 32.1% for patients treated with high-intensity statin therapy (rosuvastatin 20-40 mg/d or atorvastatin 40-80 mg/d). Among patients treated with rosuvastatin 40 mg/d and ezetimibe 10 mg/d, 53.3% achieved LDL-C <50 mg/dL. These findings underscore the need for greater usage of combination lipid-lowering therapy and agents with high LDL-C lowering efficacy.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-14DOI: 10.1016/j.ihj.2024.11.002
Kavita Singh, Dimple Kondal, Deepa Mohan, Mareesha Gandral, Sheril Rajan, Viswanathan Mohan, Mohammed K Ali, Km Venkat Narayan, Mark D Huffman, Dorairaj Prabhakaran, Nikhil Tandon
Background: Assessment of knowledge, attitudes, and practices regarding cardiovascular diseases (CVD) and cardiovascular risk factors (CVRF) is critical to inform CVD prevention strategies, but limited community-level data exist from developing countries.
Objective: To assess the knowledge, attitudes, and practices regarding CVD and CVRF and acceptability of non-physician health workers and text-message based reminders to guide CVD prevention strategies in India.
Methods: We conducted a telephone-based survey nested in the on-going Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) cohort in Delhi and Chennai, India between January 2021 to February 2021. We randomly selected people with CVRF, but no established CVD and those with existing CVD from the CARRS cohort (n = 502 participants) and assessed their 1) knowledge of CVD symptoms and risk factors, 2) attitude towards non-physician health workers (NPHW) facilitated care and text-messages for healthy lifestyle, and 3) practices regarding monitoring of CVRF. We performed logistic regression analyses to investigate the factors associated with KAP.
Results: We interviewed 502 participants (283 with CVRF and 219 with CVD); 45.8 % were female, and mean age (SD) was 48.1 (11.2) years. The knowledge of heart attack symptoms, stroke symptoms, and CVRF (>75 % correct answers) were: 12.9 %, 20.7 %, and 17.3 %, respectively. Individuals with CVRF had 2.5 times lower knowledge of CVD symptoms compared to those with existing CVD. Acceptability of NPHW-facilitated care and text-messages for healthy lifestyle was 60 % and 84 %, respectively.
Conclusion: The knowledge of CVD symptoms and risk factors is below optimal levels, particularly among individuals at high risk of CVD, unskilled workers, those with lower levels of education and income. Innovative use of NPHW along with mHealth tools could potentially offer solutions to reduce the burden of CVD.
{"title":"Community-level knowledge, attitudes, and practices regarding cardiovascular diseases and modifiable risk factors in India.","authors":"Kavita Singh, Dimple Kondal, Deepa Mohan, Mareesha Gandral, Sheril Rajan, Viswanathan Mohan, Mohammed K Ali, Km Venkat Narayan, Mark D Huffman, Dorairaj Prabhakaran, Nikhil Tandon","doi":"10.1016/j.ihj.2024.11.002","DOIUrl":"10.1016/j.ihj.2024.11.002","url":null,"abstract":"<p><strong>Background: </strong>Assessment of knowledge, attitudes, and practices regarding cardiovascular diseases (CVD) and cardiovascular risk factors (CVRF) is critical to inform CVD prevention strategies, but limited community-level data exist from developing countries.</p><p><strong>Objective: </strong>To assess the knowledge, attitudes, and practices regarding CVD and CVRF and acceptability of non-physician health workers and text-message based reminders to guide CVD prevention strategies in India.</p><p><strong>Methods: </strong>We conducted a telephone-based survey nested in the on-going Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) cohort in Delhi and Chennai, India between January 2021 to February 2021. We randomly selected people with CVRF, but no established CVD and those with existing CVD from the CARRS cohort (n = 502 participants) and assessed their 1) knowledge of CVD symptoms and risk factors, 2) attitude towards non-physician health workers (NPHW) facilitated care and text-messages for healthy lifestyle, and 3) practices regarding monitoring of CVRF. We performed logistic regression analyses to investigate the factors associated with KAP.</p><p><strong>Results: </strong>We interviewed 502 participants (283 with CVRF and 219 with CVD); 45.8 % were female, and mean age (SD) was 48.1 (11.2) years. The knowledge of heart attack symptoms, stroke symptoms, and CVRF (>75 % correct answers) were: 12.9 %, 20.7 %, and 17.3 %, respectively. Individuals with CVRF had 2.5 times lower knowledge of CVD symptoms compared to those with existing CVD. Acceptability of NPHW-facilitated care and text-messages for healthy lifestyle was 60 % and 84 %, respectively.</p><p><strong>Conclusion: </strong>The knowledge of CVD symptoms and risk factors is below optimal levels, particularly among individuals at high risk of CVD, unskilled workers, those with lower levels of education and income. Innovative use of NPHW along with mHealth tools could potentially offer solutions to reduce the burden of CVD.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-03DOI: 10.1016/j.ihj.2024.11.001
Upendra Kaul, Rishi Sethi, Sanjeeb Roy, P K Goel, Nagendra Singh Chouhan, Rajesh Vijayvergiya, Manish Narang, Priyadarshini, D K Baruah, Rony Mathew
Objectives: The prevalence of atherosclerosis and acute coronary syndrome (ACS) is increasing in young Indians (18-50 years of age). However, the characteristics of atherosclerotic plaques in such individuals are poorly understood, presenting distinct challenges for the management of ACS. This study aims to analyze plaque characteristics in young Indian patients with ACS who underwent percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) imaging.
Methods: This was a prospective, multicentric, non-interventional study on patients aged 18-50 years presenting with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction, or unstable angina, and were scheduled to undergo OCT-guided PCI. Major adverse cardiac events (MACE) were assessed post-procedure and at the 6-month and 12-month follow-ups.
Results: The study included 100 ACS patients (mean age = 43.6 ± 5.2 years), with 51% presenting with STEMI. Pre-PCI OCT assessment showed that fibrous plaques (75%) were most common followed by plaques containing macrophages (27%), microchannels (20%), and calcified nodules (14%). In addition, plaque rupture, plaque erosion, and lipid-rich plaques, along with red, white, and mixed thrombi, were observed in 31%, 25%, 24%, 21%, 14%, and 17% (total thrombus occurrence = 52%) of the patients, respectively. At 12 months, the MACE (coronary artery bypass graft) rate was 1%.
Conclusions: Young Indian patients with ACS displayed a range of plaque morphologies identified through pre-PCI OCT. Among these, fibrous plaques were the most prominent type, followed by plaques containing macrophages. Additionally, plaque rupture, plaque erosion, and lipid-rich plaques were also observed in this population.
{"title":"Morphological characterization of coronary plaques in young indian patients with acute coronary syndrome: A multicentric study.","authors":"Upendra Kaul, Rishi Sethi, Sanjeeb Roy, P K Goel, Nagendra Singh Chouhan, Rajesh Vijayvergiya, Manish Narang, Priyadarshini, D K Baruah, Rony Mathew","doi":"10.1016/j.ihj.2024.11.001","DOIUrl":"10.1016/j.ihj.2024.11.001","url":null,"abstract":"<p><strong>Objectives: </strong>The prevalence of atherosclerosis and acute coronary syndrome (ACS) is increasing in young Indians (18-50 years of age). However, the characteristics of atherosclerotic plaques in such individuals are poorly understood, presenting distinct challenges for the management of ACS. This study aims to analyze plaque characteristics in young Indian patients with ACS who underwent percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) imaging.</p><p><strong>Methods: </strong>This was a prospective, multicentric, non-interventional study on patients aged 18-50 years presenting with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction, or unstable angina, and were scheduled to undergo OCT-guided PCI. Major adverse cardiac events (MACE) were assessed post-procedure and at the 6-month and 12-month follow-ups.</p><p><strong>Results: </strong>The study included 100 ACS patients (mean age = 43.6 ± 5.2 years), with 51% presenting with STEMI. Pre-PCI OCT assessment showed that fibrous plaques (75%) were most common followed by plaques containing macrophages (27%), microchannels (20%), and calcified nodules (14%). In addition, plaque rupture, plaque erosion, and lipid-rich plaques, along with red, white, and mixed thrombi, were observed in 31%, 25%, 24%, 21%, 14%, and 17% (total thrombus occurrence = 52%) of the patients, respectively. At 12 months, the MACE (coronary artery bypass graft) rate was 1%.</p><p><strong>Conclusions: </strong>Young Indian patients with ACS displayed a range of plaque morphologies identified through pre-PCI OCT. Among these, fibrous plaques were the most prominent type, followed by plaques containing macrophages. Additionally, plaque rupture, plaque erosion, and lipid-rich plaques were also observed in this population.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transfemoral Trans-catheter Aortic Valve Replacement (TF-TAVR) is a safe alternative to surgical aortic valve replacement (SAVR). Protamine is used to reverse heparin and reduce post-TAVR bleeding, but concerns about risks like valve thrombosis and stroke remain. This systematic review and meta-analysis, following PRISMA guidelines, found no statistically significant difference in major bleeding complications between the protamine and control groups [(3.0 % vs. 14.4 %); RR: 0.56; P = 0.16]. No differences were noted in life-threatening bleeding, blood transfusions, 30-day mortality, or stroke. Protamine appears safe post-TAVR without increasing stroke risk, but its effectiveness in reducing bleeding needs further investigation through a multicentric randomized study.
经口经导管主动脉瓣置换术（TF-TAVR）是外科主动脉瓣置换术（SAVR）的安全替代方案。原胺用于逆转肝素并减少TAVR术后出血，但对瓣膜血栓和中风等风险的担忧依然存在。这项系统回顾和荟萃分析遵循了 PRISMA 指南，发现在大出血并发症方面，丙胺组和对照组之间没有统计学意义上的显著差异[（3.0 % vs. 14.4 %）；RR：0.56；P = 0.16]。在危及生命的出血、输血、30 天死亡率或中风方面没有差异。TAVR术后使用普罗胺似乎是安全的，不会增加中风风险，但其减少出血的效果还需要通过多中心随机研究进行进一步调查。
{"title":"Safety and efficacy of protamine after transcatheter aortic valve replacement","authors":"Lakshmi Durga Kumaraguruparan , Asuwin Anandaram , Kamalakkannan G. Sambandam , Yogapriya Chidambaram , Bharath Raj Kidambi , Gautam Ganesan Karthikeyan , Madhesh Kasi , Rizwan Suliankatchi Abdulkader , Sankaran Ramesh , Vadivelu Ramalingam , Ravindran Rajendran , Nagendra Boopathy Senguttuvan","doi":"10.1016/j.ihj.2024.09.001","DOIUrl":"10.1016/j.ihj.2024.09.001","url":null,"abstract":"<div><div>Transfemoral Trans-catheter Aortic Valve Replacement (TF-TAVR) is a safe alternative to surgical aortic valve replacement (SAVR). Protamine is used to reverse heparin and reduce post-TAVR bleeding, but concerns about risks like valve thrombosis and stroke remain. This systematic review and meta-analysis, following PRISMA guidelines, found no statistically significant difference in major bleeding complications between the protamine and control groups [(3.0 % vs. 14.4 %); RR: 0.56; P = 0.16]. No differences were noted in life-threatening bleeding, blood transfusions, 30-day mortality, or stroke. Protamine appears safe post-TAVR without increasing stroke risk, but its effectiveness in reducing bleeding needs further investigation through a multicentric randomized study.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"76 5","pages":"Pages 352-354"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.ihj.2024.10.006
Rajesh Kumar, Naveed Ullah Khan, Ayaz Mir, Khalid Naseeb, Gulzar Ali, Arti Ashok, Mukesh Kumar, Abiha Urooj, Uroosa Safdar, Aisha Hussain, Muhammad Ishaq, Tahir Saghir, Jawaid Akbar Sial, Abdul Hakeem, Musa Karim
Background
Limited data exist on the role of coronary collaterals circulation (CCC) in patients with ST-elevation acute coronary syndrome (STE-ACS). This study aimed to assess CCC and the in-hospital course of patients with CCC undergoing primary percutaneous coronary intervention (pPCI).
Methods
The study included consecutive STE-ACS patients undergoing pPCI. Good CCC was defined as Rentrop collateral score (RCS) of 2–3. Patients with good and poor CCC were compared regarding clinical characteristics, angiographic patterns, and hospital course.
Results
In the sample of 4683 patients, mean age was 55.6 ± 11 years, and 78.8 % were male. Good CCC was observed in 499 (10.7 %) patients. The rate of intra-procedure slow-flow/no-reflow (SF/NR) was 29.9 % vs. 20.5 % (p < 0.001), and the rate of composite adverse clinical outcomes (CACO) was 21.2 % vs. 19 % (p = 0.225) for patients with good and poor CCC, respectively. Multivariable analysis identified left ventricular end-diastolic pressure (LVEDP), multi-vessel disease (MVD), and thrombus grade ≥4 as independent predictors of good CCC, with adjusted odds ratios of 0.98 [0.97–0.99], 1.69 [1.35–2.10], and 3.45 [2.64–4.52], respectively. In propensity-matched cohorts, the intra-procedure SF/NR rate was 29.9 % vs. 26.9 % (p = 0.292), and the rate of CACO was 21.2 % vs. 23.4 % (p = 0.403) for patients with good and poor CCC, respectively.
Conclusion
Angiographic evidence of good CCC in STE-ACS patients was limited. Good CCC was associated with a higher prevalence of MVD, high thrombus burden, and low pre-procedure LVEDP, resulting in a higher incidence of intra-procedure SF/NR. However, the CACO did not differ significantly between patients with good and poor CCC.
{"title":"Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital course","authors":"Rajesh Kumar, Naveed Ullah Khan, Ayaz Mir, Khalid Naseeb, Gulzar Ali, Arti Ashok, Mukesh Kumar, Abiha Urooj, Uroosa Safdar, Aisha Hussain, Muhammad Ishaq, Tahir Saghir, Jawaid Akbar Sial, Abdul Hakeem, Musa Karim","doi":"10.1016/j.ihj.2024.10.006","DOIUrl":"10.1016/j.ihj.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Limited data exist on the role of coronary collaterals circulation (CCC) in patients with ST-elevation acute coronary syndrome (STE-ACS). This study aimed to assess CCC and the in-hospital course of patients with CCC undergoing primary percutaneous coronary intervention (pPCI).</div></div><div><h3>Methods</h3><div>The study included consecutive STE-ACS patients undergoing pPCI. Good CCC was defined as Rentrop collateral score (RCS) of 2–3. Patients with good and poor CCC were compared regarding clinical characteristics, angiographic patterns, and hospital course.</div></div><div><h3>Results</h3><div>In the sample of 4683 patients, mean age was 55.6 ± 11 years, and 78.8 % were male. Good CCC was observed in 499 (10.7 %) patients. The rate of intra-procedure slow-flow/no-reflow (SF/NR) was 29.9 % vs. 20.5 % (p < 0.001), and the rate of composite adverse clinical outcomes (CACO) was 21.2 % vs. 19 % (p = 0.225) for patients with good and poor CCC, respectively. Multivariable analysis identified left ventricular end-diastolic pressure (LVEDP), multi-vessel disease (MVD), and thrombus grade ≥4 as independent predictors of good CCC, with adjusted odds ratios of 0.98 [0.97–0.99], 1.69 [1.35–2.10], and 3.45 [2.64–4.52], respectively. In propensity-matched cohorts, the intra-procedure SF/NR rate was 29.9 % vs. 26.9 % (p = 0.292), and the rate of CACO was 21.2 % vs. 23.4 % (p = 0.403) for patients with good and poor CCC, respectively.</div></div><div><h3>Conclusion</h3><div>Angiographic evidence of good CCC in STE-ACS patients was limited. Good CCC was associated with a higher prevalence of MVD, high thrombus burden, and low pre-procedure LVEDP, resulting in a higher incidence of intra-procedure SF/NR. However, the CACO did not differ significantly between patients with good and poor CCC.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"76 5","pages":"Pages 358-363"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.ihj.2024.10.005
Maitri M. Patel , Sumantkumar G. Patel , Jigar K. Patel , Dhruvkumar M. Patel , Poojan J. Prajapati , Harsh D. Patel , Jayesh S. Prajapati , Lalitkumar B. Patel , Mukundkumar V. Patel
Consecutive suspected acute coronary syndrome (ACS) cases were categorized into three groups: Group-1 (ST-depression), Group-2 (T-inversion), and Group-3 (remaining cases). Group-3 was subclassified into isoelectric horizontal ST-segment with sharp ST-T-angle (IHST) positive and IHST negative groups. They underwent serial high-sensitive Troponin-I testing. ACS incidence was 77.96 %, with 33.02 %, 15.96 %, and (15.04 %, 35.96 %) of patients in Groups 1, 2, and 3 (IHST positive, IHST negative), respectively. The presence of IHST exhibited higher sensitivity than T-inversion and greater specificity than ST-depression in detecting ACS. The presence of IHST sign additionally detected 15.04 % of ACS. The presence of IHST was significant among group-3 (p = 0.008) as well as the overall ACS cases (p = 0.048).
{"title":"A groundbreaking electrocardiographic observation: “Isoelectric horizontal ST-segment with sharp ST-T angle” a novel sign for acute coronary syndrome","authors":"Maitri M. Patel , Sumantkumar G. Patel , Jigar K. Patel , Dhruvkumar M. Patel , Poojan J. Prajapati , Harsh D. Patel , Jayesh S. Prajapati , Lalitkumar B. Patel , Mukundkumar V. Patel","doi":"10.1016/j.ihj.2024.10.005","DOIUrl":"10.1016/j.ihj.2024.10.005","url":null,"abstract":"<div><div>Consecutive suspected acute coronary syndrome (ACS) cases were categorized into three groups: Group-1 (ST-depression), Group-2 (T-inversion), and Group-3 (remaining cases). Group-3 was subclassified into isoelectric horizontal ST-segment with sharp ST-T-angle (IHST) positive and IHST negative groups. They underwent serial high-sensitive Troponin-I testing. ACS incidence was 77.96 %, with 33.02 %, 15.96 %, and (15.04 %, 35.96 %) of patients in Groups 1, 2, and 3 (IHST positive, IHST negative), respectively. The presence of IHST exhibited higher sensitivity than T-inversion and greater specificity than ST-depression in detecting ACS. The presence of IHST sign additionally detected 15.04 % of ACS. The presence of IHST was significant among group-3 (p = 0.008) as well as the overall ACS cases (p = 0.048).</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"76 5","pages":"Pages 349-351"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.ihj.2024.07.009
Anil Kumar Boddu, Bijulal S, Krishnamoorthy Km, Ajit Kumar Vk
Objective
To evaluate the long-term clinical outcomes of percutaneous coronary intervention (PCI) in patients who had previously undergone coronary artery bypass grafting (CABG).
Method
A total of 219 patients who had a history of CABG and underwent PCI at tertiary care centre were retrospectively enrolled in this study. Clinical endpoints such as major adverse cardiac events (MACE; cardiac death, non-fatal myocardial infarction [MI], and target vessel revascularization), any death, cardiac death, MI, target vessel revascularization (TVR), and target lesion revascularisation (TLR) were reported at long-term follow-up.
Results
About 66.6 % patients were treated on the native vessel, and 24.2 % on grafts vessel. In all, 360 stents [83.3 % drug-eluting stent (DES) and 16.6 % bare metal stent (BMS)] were implanted. Diabetes mellitus (p = 0.03), LVEF<55 % for PCI (p = 0.04), stent type [BMS (p < 0.001) and DES (p < 0.001)] and chronic kidney disease [(CKD) p < 0.01] were appeared to be the significant predictors of mortality. Age at CABG>50 years (p = 0.04), stent type [BMS (p = 0.03) and DES (p < 0.01)] and CKD (p < 0.01) as independent predictors for MACE. Higher event rate was reported in graft-vessel PCI group as compared to native-vessel PCI group: ISR (p < 0.01), TLR (p = 0.01), mortality (p = 0.04), MACE (p < 0.01) and MI (p = 0.05). Mortality (p < 0.001), MACE (p < 0.001) and MI (p < 0.001) were significantly lower in DES vs. BMS groups.
Conclusion
Native-vessel PCI was associated with better clinical outcomes than graft-vessel PCI that also with the use of DES as the first choice in patients with a history of CABG.
{"title":"Long-term outcomes of percutaneous coronary intervention in patients with prior coronary artery bypass graft - A retrospective experience","authors":"Anil Kumar Boddu, Bijulal S, Krishnamoorthy Km, Ajit Kumar Vk","doi":"10.1016/j.ihj.2024.07.009","DOIUrl":"10.1016/j.ihj.2024.07.009","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the long-term clinical outcomes of percutaneous coronary intervention (PCI) in patients who had previously undergone coronary artery bypass grafting (CABG).</div></div><div><h3>Method</h3><div>A total of 219 patients who had a history of CABG and underwent PCI at tertiary care centre were retrospectively enrolled in this study. Clinical endpoints such as major adverse cardiac events (MACE; cardiac death, non-fatal myocardial infarction [MI], and target vessel revascularization), any death, cardiac death, MI, target vessel revascularization (TVR), and target lesion revascularisation (TLR) were reported at long-term follow-up.</div></div><div><h3>Results</h3><div>About 66.6 % patients were treated on the native vessel, and 24.2 % on grafts vessel. In all, 360 stents [83.3 % drug-eluting stent (DES) and 16.6 % bare metal stent (BMS)] were implanted. Diabetes mellitus (<em>p</em> = 0.03), LVEF<55 % for PCI (<em>p</em> = 0.04), stent type [BMS (<em>p</em> < 0.001) and DES (<em>p</em> < 0.001)] and chronic kidney disease [(CKD) <em>p</em> < 0.01] were appeared to be the significant predictors of mortality. Age at CABG>50 years (<em>p</em> = 0.04), stent type [BMS (<em>p</em> = 0.03) and DES (<em>p</em> < 0.01)] and CKD (<em>p</em> < 0.01) as independent predictors for MACE. Higher event rate was reported in graft-vessel PCI group as compared to native-vessel PCI group: ISR (<em>p</em> < 0.01), TLR (<em>p</em> = 0.01), mortality (<em>p</em> = 0.04), MACE (<em>p</em> < 0.01) and MI (<em>p</em> = 0.05). Mortality (<em>p</em> < 0.001), MACE (<em>p</em> < 0.001) and MI (<em>p</em> < 0.001) were significantly lower in DES vs. BMS groups.</div></div><div><h3>Conclusion</h3><div>Native-vessel PCI was associated with better clinical outcomes than graft-vessel PCI that also with the use of DES as the first choice in patients with a history of CABG.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"76 5","pages":"Pages 321-326"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To identify incidence, type of drug abuse study clinical and angiographic profile in very young population presenting with acute coronary syndrome (ACS).
Materials and methods
All consecutive patients less than 30 years with ACS included and segregated into Group 1 and 2 (with and without drug abuse respectively)
Result
n = 153; n = 17 in group 1 of whom 35.29 % consumed opium, 17.64 % energy drinks, 17.64 % whey protein supplements, 17.64 % inhaled marijuana, 5.88 % heroin and spasmoproxyvon and 23.52 % multi-substance abusers. STEMI, Single vessel disease and urban domicile were predominant. Rising trends of drug abuse were identified in prospective (28.20 %) versus retrospective (5.30 %) timeframe (p = 0.011).
Conclusion
Rising trends of drug abuse, a potentially modifiable risk factor of ACS in the young are alarming. Strict regulations are needed to curb this menace.
{"title":"Drug abuse and ACS in the very young (less than 30 years): Demographic, clinical and angiographic profile","authors":"Shibba Takkar Chhabra , Gurleen Kaur , Samir Kapoor , Aastha Kapila , Gagandeep Kaur , Prannav Jain , Pankaj kumar , Namita Bansal , Mamta Bansal , Anshuman Gupta , Akash Batta , Gautam Singal , Abhishek Goyal , Rohit Tandon , Naved Aslam , Bishav Mohan , Gurpreet Singh Wander","doi":"10.1016/j.ihj.2024.10.003","DOIUrl":"10.1016/j.ihj.2024.10.003","url":null,"abstract":"<div><h3>Aim</h3><div>To identify incidence, type of drug abuse study clinical and angiographic profile in very young population presenting with acute coronary syndrome (ACS).</div></div><div><h3>Materials and methods</h3><div>All consecutive patients less than 30 years with ACS included and segregated into Group 1 and 2 (with and without drug abuse respectively)</div></div><div><h3>Result</h3><div><em>n</em> = 153; <em>n</em> = 17 in group 1 of whom 35.29 % consumed opium, 17.64 % energy drinks, 17.64 % whey protein supplements, 17.64 % inhaled marijuana, 5.88 % heroin and spasmoproxyvon and 23.52 % multi-substance abusers. STEMI, Single vessel disease and urban domicile were predominant. Rising trends of drug abuse were identified in prospective (28.20 %) versus retrospective (5.30 %) timeframe (<em>p</em> = 0.011).</div></div><div><h3>Conclusion</h3><div>Rising trends of drug abuse, a potentially modifiable risk factor of ACS in the young are alarming. Strict regulations are needed to curb this menace.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"76 5","pages":"Pages 355-357"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.ihj.2024.10.002
Deep Dutta , Kunal Mahajan , Lokesh Verma , Gunjan Gupta , Meha Sharma
Background
Gender differences in acute coronary syndrome (ACS) outcomes have been noted in global data, which however did not analyse Indian data. No prior systematic review and meta-analysis (SRM) has addressed this important aspect of gender bias in Indian women with ACS. Hence this SRM aimed to address this knowledge gap.
Methods
Electronic databases were searched for studies in ACS comparing cardiovascular disease presentation, treatment received and outcomes in women and men from India. Primary outcomes were to evaluate gender-differences in 30-day death and major adverse cardiovascular events (MACE). Secondary outcomes were to evaluate gender-differences in presentation, management and mortality. The SRM is registered with PROSPERO (CRD42023477286).
Results
From initially screened 3753 articles, data from 9 studies (61,185 patients) were analysed. Women with ACS had higher prevalence of diabetes [Odds ratio (OR) 1.65(95%CI:1.33–2.04); p < 0.001; I2 = 95 %] and hypertension [OR2.06(95%CI:1.88–2.25); p < 0.001; I2 = 42 %]. Smoking was significantly lower in women [OR 0.05(95%CI:0.03–0.07); p < 0.001; I2 = 87 %]. Non-ST elevation myocardial infarction (NSTEMI) was significantly higher in women [OR 1.92(95%CI:1.66–2.21); p < 0.001; I2 = 0 %]. Diagnostic angiography [OR 0.64(95%CI:0.56–0.74); p < 0.001; I2 = 46 %] and percutaneous coronary interventions [OR0.71(95%CI:0.55–0.92); p = 0.01; I2 = 92 %] were significantly lower in women. Women had significantly higher 30-day mortality [Hazard ratio (HR)2.26(95%CI:2.01–2.55); p < 0.001; I2 = 6 %], 1-year mortality [HR2.41(95%CI:1.89–3.07); p < 0.001; I2 = 53 %], in-hospital death [HR1.88(95%CI:1.19–2.96); p = 0.007; I2 = 92 %], stroke [HR 1.84 (95%CI:1.34–2.52); p < 0.001; I2 = 0 %] and MACE outcomes [OR 2.05 (95%CI:1.78–2.35); p < 0.001]. Use of aspirin, clopidogrel, beta-blockers and nitrates were significantly lower in women.
Conclusion
Our study highlights worse outcomes in Indian women with ACS. Higher burden of diabetes and hypertension, decreased used of PCI and lesser aggressive pharmacotherapy may be some of the contributing factors.
{"title":"Gender differences in the management and outcomes of acute coronary syndrome in indians: A systematic review and meta-analysis","authors":"Deep Dutta , Kunal Mahajan , Lokesh Verma , Gunjan Gupta , Meha Sharma","doi":"10.1016/j.ihj.2024.10.002","DOIUrl":"10.1016/j.ihj.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Gender differences in acute coronary syndrome (ACS) outcomes have been noted in global data, which however did not analyse Indian data. No prior systematic review and meta-analysis (SRM) has addressed this important aspect of gender bias in Indian women with ACS. Hence this SRM aimed to address this knowledge gap.</div></div><div><h3>Methods</h3><div>Electronic databases were searched for studies in ACS comparing cardiovascular disease presentation, treatment received and outcomes in women and men from India. Primary outcomes were to evaluate gender-differences in 30-day death and major adverse cardiovascular events (MACE). Secondary outcomes were to evaluate gender-differences in presentation, management and mortality. The SRM is registered with PROSPERO (CRD42023477286).</div></div><div><h3>Results</h3><div>From initially screened 3753 articles, data from 9 studies (61,185 patients) were analysed. Women with ACS had higher prevalence of diabetes [Odds ratio (OR) 1.65(95%CI:1.33–2.04); <em>p</em> < 0.001; I<sup>2</sup> = 95 %] and hypertension [OR2.06(95%CI:1.88–2.25); <em>p</em> < 0.001; I<sup>2</sup> = 42 %]. Smoking was significantly lower in women [OR 0.05(95%CI:0.03–0.07); <em>p</em> < 0.001; I<sup>2</sup> = 87 %]. Non-ST elevation myocardial infarction (NSTEMI) was significantly higher in women [OR 1.92(95%CI:1.66–2.21); <em>p</em> < 0.001; I<sup>2</sup> = 0 %]. Diagnostic angiography [OR 0.64(95%CI:0.56–0.74); <em>p</em> < 0.001; I<sup>2</sup> = 46 %] and percutaneous coronary interventions [OR0.71(95%CI:0.55–0.92); <em>p</em> = 0.01; I<sup>2</sup> = 92 %] were significantly lower in women. Women had significantly higher 30-day mortality [Hazard ratio (HR)2.26(95%CI:2.01–2.55); <em>p</em> < 0.001; I<sup>2</sup> = 6 %], 1-year mortality [HR2.41(95%CI:1.89–3.07); <em>p</em> < 0.001; I<sup>2</sup> = 53 %], in-hospital death [HR1.88(95%CI:1.19–2.96); <em>p</em> = 0.007; I<sup>2</sup> = 92 %], stroke [HR 1.84 (95%CI:1.34–2.52); <em>p</em> < 0.001; I<sup>2</sup> = 0 %] and MACE outcomes [OR 2.05 (95%CI:1.78–2.35); <em>p</em> < 0.001]. Use of aspirin, clopidogrel, beta-blockers and nitrates were significantly lower in women.</div></div><div><h3>Conclusion</h3><div>Our study highlights worse outcomes in Indian women with ACS. Higher burden of diabetes and hypertension, decreased used of PCI and lesser aggressive pharmacotherapy may be some of the contributing factors.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"76 5","pages":"Pages 333-341"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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