A. Islam, S. Munwar, Azfar D Hossain, A. Reza, S. Talukder, T. Ahmed, Kazi Atiqur Rahman
Background: Importance of Physiological study by Fractional Flow Reserve (FFR) in the management of patient with coronary artery disease (CAD is well established. Objective: Angiographic-guided percutaneous coronary intervention (PCI) is a common practice in Bangladeshi interventional era. Data on Pre-PCI physiological study by Fractional Flow Reserve (FFR) in our patient is not available. Therefore, our primary aim was to perform pre-PCI FFR to assess the angiographically significant coronary stenosis and thus to avoid inappropriate stenting. Methods: Total 22 patients (Male 20, Female 2) were enrolled in this observational non-randomized prospective cohort. Patient who had angiographically significant lesion, planned for physiological study by pre-PCI FFR. Cut off value for FFR were clinically significant only if Pd/Pa ratio <0.75 and differed stenting if > 0.76-0.80 or above. Results: In the studied patient population, FFR done in total 27 vessels of 22 patients. Among the vessel wise FFR distribution were in LAD 67%(18), LCX 14.8%(4), RCA 14.8%(4) and Ramus Intermedius 3.7% (1). FFR was nonsignificant (<0.75) in 59% (13) patients and significant (>0.75) were in 41%(9) patients. Conclusion: In this single center, very preliminary observational prospective cohort of non-randomized study, we found, that FFR is an important aid to perform PCI in patient with angiographically significant coronary lesion, and to avoid inappropriate stenting of insignificant stenosis by physiological study. Thus, to reduce cost and untoward effects of inappropriate stenting. Bangladesh Heart Journal 2019; 34(1) : 37-43
{"title":"Fractional Flow Reserve (FFR) guided Percutaneous Coronary Intervention (PCI) to Avoid Inappropriate Stenting in Patient with Angiographically Significant Stenotic Coronary Artery Lesion–Our Experiences at Apollo Hospitals Dhaka","authors":"A. Islam, S. Munwar, Azfar D Hossain, A. Reza, S. Talukder, T. Ahmed, Kazi Atiqur Rahman","doi":"10.3329/BHJ.V34I1.41906","DOIUrl":"https://doi.org/10.3329/BHJ.V34I1.41906","url":null,"abstract":"Background: Importance of Physiological study by Fractional Flow Reserve (FFR) in the management of patient with coronary artery disease (CAD is well established. \u0000Objective: Angiographic-guided percutaneous coronary intervention (PCI) is a common practice in Bangladeshi interventional era. Data on Pre-PCI physiological study by Fractional Flow Reserve (FFR) in our patient is not available. Therefore, our primary aim was to perform pre-PCI FFR to assess the angiographically significant coronary stenosis and thus to avoid inappropriate stenting. \u0000Methods: Total 22 patients (Male 20, Female 2) were enrolled in this observational non-randomized prospective cohort. Patient who had angiographically significant lesion, planned for physiological study by pre-PCI FFR. Cut off value for FFR were clinically significant only if Pd/Pa ratio <0.75 and differed stenting if > 0.76-0.80 or above. \u0000Results: In the studied patient population, FFR done in total 27 vessels of 22 patients. Among the vessel wise FFR distribution were in LAD 67%(18), LCX 14.8%(4), RCA 14.8%(4) and Ramus Intermedius 3.7% (1). FFR was nonsignificant (<0.75) in 59% (13) patients and significant (>0.75) were in 41%(9) patients. \u0000Conclusion: In this single center, very preliminary observational prospective cohort of non-randomized study, we found, that FFR is an important aid to perform PCI in patient with angiographically significant coronary lesion, and to avoid inappropriate stenting of insignificant stenosis by physiological study. Thus, to reduce cost and untoward effects of inappropriate stenting. \u0000Bangladesh Heart Journal 2019; 34(1) : 37-43","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121585196","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}
Armane Wadud, Syed Tanvir Ahmed, S. Aziz, I. Khalilullah, C. Kabir
Objectives: The objective of this study was to see whether there is an association between high blood glucose levels after operation under CPB and post operative morbidity and mortality. Methodology: This cohort study was carried out in the Department of Cardiac Surgery at National Institute of Cardiovascular DiseaseS (NICVD), Sher-e-Bangla Nagar, Dhaka from January, 2012 to December, 2013 for a period of twenty four (24) months. A total number of 110 patients who underwent MVR operation with CPB were enrolled in this study as per inclusion and exclusion criteria. Patients were divided into two groups according to their post operative blood glucose levels, recorded with in first 60 hrs after mitral valve replacement surgery under cardiopulmonay bypass. Patients having blood glucose level of less than 10.1 mmol/L (unexposed) and patients having blood lactate level of 10.1 mmol/L or more (exposed) were grouped. Post operative variables were observed and recorded during the hospital course of the patient. Result: A total number of 110 patients were enrolled in this study. Blood glucose levels lower than or equal to10 mmol/L after MVR were present in 55(50%) patients (Group A) Blood glucose levels higher than 10 mmol/L after MVR were present in 55(50%) patients. Postoperative morbidity was higher in this group ( Group B) than in the patients who had peak blood glucose levels of less than or equal to 10 mmol/L MVR (p 0.001). Postoperative ICU stay was prolonged in patients with elevated levels of blood glucose after MVR under CPB compared with of patients with lower blood glucose levels (p 0.001). Other common morbidities are neurological complication (p 0.04), renal dysfunction (p 0.01) , wound infection (p 0.04), post-operative hospital stay ( p0.004). also higher in group B patient, as well as mortality. Conclusions: Blood glucose concentration of 10.1 mmol/ L or higher after MVR under CPB is an important issues related to postoperative morbidity and mortality. Bangladesh Heart Journal 2019; 34(1) : 44-51
{"title":"Effects of Controling of Post Operative Hypergycemia (Stress Induced Hyperglycemia) in Adult Non-Diabetic Patients Undergoing Mitral Valve Replacement Surgery Under Cardiopulmonary Bypass","authors":"Armane Wadud, Syed Tanvir Ahmed, S. Aziz, I. Khalilullah, C. Kabir","doi":"10.3329/BHJ.V34I1.41907","DOIUrl":"https://doi.org/10.3329/BHJ.V34I1.41907","url":null,"abstract":"Objectives: The objective of this study was to see whether there is an association between high blood glucose levels after operation under CPB and post operative morbidity and mortality. \u0000Methodology: This cohort study was carried out in the Department of Cardiac Surgery at National Institute of Cardiovascular DiseaseS (NICVD), Sher-e-Bangla Nagar, Dhaka from January, 2012 to December, 2013 for a period of twenty four (24) months. A total number of 110 patients who underwent MVR operation with CPB were enrolled in this study as per inclusion and exclusion criteria. Patients were divided into two groups according to their post operative blood glucose levels, recorded with in first 60 hrs after mitral valve replacement surgery under cardiopulmonay bypass. Patients having blood glucose level of less than 10.1 mmol/L (unexposed) and patients having blood lactate level of 10.1 mmol/L or more (exposed) were grouped. Post operative variables were observed and recorded during the hospital course of the patient. \u0000Result: A total number of 110 patients were enrolled in this study. Blood glucose levels lower than or equal to10 mmol/L after MVR were present in 55(50%) patients (Group A) Blood glucose levels higher than 10 mmol/L after MVR were present in 55(50%) patients. Postoperative morbidity was higher in this group ( Group B) than in the patients who had peak blood glucose levels of less than or equal to 10 mmol/L MVR (p 0.001). Postoperative ICU stay was prolonged in patients with elevated levels of blood glucose after MVR under CPB compared with of patients with lower blood glucose levels (p 0.001). Other common morbidities are neurological complication (p 0.04), renal dysfunction (p 0.01) , wound infection (p 0.04), post-operative hospital stay ( p0.004). also higher in group B patient, as well as mortality. \u0000Conclusions: Blood glucose concentration of 10.1 mmol/ L or higher after MVR under CPB is an important issues related to postoperative morbidity and mortality. \u0000Bangladesh Heart Journal 2019; 34(1) : 44-51","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"1966 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131324531","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}
A. Mahmud, F. Sazzad, M. Wadud, Iftakher Raja Chowdhury, M. Rahman, Haroon Rasheed Chowdhury, Noel Cipriyan Gomes, S. Choudhury, Quamrul Islam Talukdar, P. K. Chanda, F. Ahmed
Background: Preoperative risk assessment before cardiac surgery to predict mortality become literally important and practicing worldwide, whereas EuroSCORE II is most updated and popular. So we examined the hypothesis that Performance of EuroSCORE II in predicting early mortality after Mitral, Aortic or mitral & aortic valve surgery patients in National Heart Foundation Hospital and Research Institute. Objectives: To compare Euro SCORE II predicted early mortality and observed early mortality in a sample of patients of National Heart Foundation Hospital who underwent for Mitral, Aortic or Mitral & Aortic valve surgery. Methods: An observational prospective study was done in Department of cardiac surgery, National Heart Foundation Hospital and Research Institute who underwent for Mitral, Aortic or Mitral & Aortic valve surgery in the period of July 2016 to March 2018. Sample size was 356 and all inclusion criteria full filled. Patients were divided into 3 group (low, medium & high) depending on the score. Model discrimination and calibration were assessed additive and logistic EuroSCORE and EuroSCORE II. Results: The in hospital mortality of this series was 2.8% (10 out of 356) and the predicted mortality was 2.73% (95% CI 1.02-4.38) by the EuroSCORE II, 2.15% (95% CI 0.68- 3.72) by the additive method and 2.25% (95% CI 0.74-3.86) by the logistic EuroSCORE. The model’s discriminatory power also good and useful as indicated by an area under ROC curve of 0.779 in EuroSCORE II model, 0.675 in additive method and 0.696 in logistic method that means EuroSCORE II method can predict the outcome with 77% accuracy, additive method with 67% accuracy and the logistic method does that with 69% accuracy. Conclusion: EuroSCORE II was validated and performed well on National Heart Foundation patients and could be recommended as a simple risk stratification system to estimate the probability of early mortality in patients scheduled for valve surgery in Bangladesh. Bangladesh Heart Journal 2019; 34(1) : 11-24
背景:心脏手术前的术前风险评估预测死亡率在世界范围内变得非常重要和实践，而EuroSCORE II是最新和最流行的。因此，我们对国家心脏基金会医院和研究所的二尖瓣、主动脉瓣或二尖瓣+主动脉瓣手术患者的早期死亡率进行了假设检验。目的:比较Euro SCORE II在国家心脏基金会医院接受二尖瓣、主动脉瓣或二尖瓣和主动脉瓣手术的患者样本中预测的早期死亡率和观察到的早期死亡率。方法:对2016年7月至2018年3月在国立心脏基金会医院心脏外科接受二尖瓣、主动脉瓣或二尖瓣+主动脉瓣手术的患者进行观察性前瞻性研究。样本量为356例，符合所有纳入标准。根据评分将患者分为低、中、高3组。对模型判别和校准进行添加剂和logistic EuroSCORE和EuroSCORE II评估。结果:该系列的住院死亡率为2.8%(356例中有10例)，EuroSCORE II预测死亡率为2.73% (95% CI 1.02-4.38)，加性法预测死亡率为2.15% (95% CI 0.68- 3.72)， logistic EuroSCORE预测死亡率为2.25% (95% CI 0.74-3.86)。EuroSCORE II模型的ROC曲线下面积为0.779，加性方法为0.675,logistic方法为0.696，表明该模型的判别能力也很好，很有用，这意味着EuroSCORE II方法预测结果的准确率为77%，加性方法为67%，logistic方法为69%。结论:EuroSCORE II在国家心脏基金会患者中得到了验证和良好的效果，可以推荐作为一个简单的风险分层系统来估计孟加拉国瓣膜手术患者的早期死亡概率。孟加拉国心脏杂志2019;34(1): 11-24
{"title":"Performance of EuroSCORE II in Predicting Early Mortality after Mitral, Aortic or Mitral & Aortic Valve Surgery Patients in National Heart Foundation Hospital and Research Institute","authors":"A. Mahmud, F. Sazzad, M. Wadud, Iftakher Raja Chowdhury, M. Rahman, Haroon Rasheed Chowdhury, Noel Cipriyan Gomes, S. Choudhury, Quamrul Islam Talukdar, P. K. Chanda, F. Ahmed","doi":"10.3329/BHJ.V34I1.41903","DOIUrl":"https://doi.org/10.3329/BHJ.V34I1.41903","url":null,"abstract":"Background: Preoperative risk assessment before cardiac surgery to predict mortality become literally important and practicing worldwide, whereas EuroSCORE II is most updated and popular. So we examined the hypothesis that Performance of EuroSCORE II in predicting early mortality after Mitral, Aortic or mitral & aortic valve surgery patients in National Heart Foundation Hospital and Research Institute. \u0000Objectives: To compare Euro SCORE II predicted early mortality and observed early mortality in a sample of patients of National Heart Foundation Hospital who underwent for Mitral, Aortic or Mitral & Aortic valve surgery. Methods: An observational prospective study was done in Department of cardiac surgery, National Heart Foundation Hospital and Research Institute who underwent for Mitral, Aortic or Mitral & Aortic valve surgery in the period of July 2016 to March 2018. Sample size was 356 and all inclusion criteria full filled. Patients were divided into 3 group (low, medium & high) depending on the score. Model discrimination and calibration were assessed additive and logistic EuroSCORE and EuroSCORE II. \u0000Results: The in hospital mortality of this series was 2.8% (10 out of 356) and the predicted mortality was 2.73% (95% CI 1.02-4.38) by the EuroSCORE II, 2.15% (95% CI 0.68- 3.72) by the additive method and 2.25% (95% CI 0.74-3.86) by the logistic EuroSCORE. The model’s discriminatory power also good and useful as indicated by an area under ROC curve of 0.779 in EuroSCORE II model, 0.675 in additive method and 0.696 in logistic method that means EuroSCORE II method can predict the outcome with 77% accuracy, additive method with 67% accuracy and the logistic method does that with 69% accuracy. \u0000Conclusion: EuroSCORE II was validated and performed well on National Heart Foundation patients and could be recommended as a simple risk stratification system to estimate the probability of early mortality in patients scheduled for valve surgery in Bangladesh. \u0000Bangladesh Heart Journal 2019; 34(1) : 11-24","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128789468","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}
Background: Intra-cardiac mass, particularly myxoma operation is common at NICVD .Its frequency is about 1-2% among all operations done here. The main aim of this study was to analyze the different aspects of this tumour and its surgery on 62 patients operated over last three years (2015-2017). Methods: It is a retrospective study .The data were collected over a period of 03 years (2015-2017) For this I studied the ward admission register, OT and ICU registers ,ICU flow charts, talked with the respective unit doctors to collect my data. Then the data were analyzed manually and by computer. Results: Age range of the patients were from 7.5 years to 65years with a mean±SD (36.94±13.99). Male and female patient ratio were M:F=1:1.81.Myxoma were more common in the 4th and 5th decade of life in this study population .Preoperative time delay for operation after hospital admission was 9±2.12days.All the operations were done as an elective procedure rather urgent or emergency procedure. Post operative mortality was around 12.90% among these patients. The causes of high mortality following myxoma operation were Low Output Syndrome, Congestive Heart Failure , Cerebral stroke and septicaemia. Conclusion: Myxoma operation is common in NICVD. Most of our patients were dealt as a routine procedure. Their features and surgical procedure were similar with a little difference among the neighbouring countries. Our post operative outcome was a little bit worse (12.90% mortality) over the mentioned period. We need to find out the causes and to take care of these patients to reduce mortality in future. Bangladesh Heart Journal 2018; 33(2) : 85-89
{"title":"A Snapshot on Myxoma Operation of 62 Patients at National Institute of Cardiovascular Diseases(NICVD), Dhaka, Bangladesh","authors":"K. Islam","doi":"10.3329/bhj.v33i2.39302","DOIUrl":"https://doi.org/10.3329/bhj.v33i2.39302","url":null,"abstract":"Background: Intra-cardiac mass, particularly myxoma operation is common at NICVD .Its frequency is about 1-2% among all operations done here. The main aim of this study was to analyze the different aspects of this tumour and its surgery on 62 patients operated over last three years (2015-2017). \u0000Methods: It is a retrospective study .The data were collected over a period of 03 years (2015-2017) For this I studied the ward admission register, OT and ICU registers ,ICU flow charts, talked with the respective unit doctors to collect my data. Then the data were analyzed manually and by computer. \u0000Results: Age range of the patients were from 7.5 years to 65years with a mean±SD (36.94±13.99). Male and female patient ratio were M:F=1:1.81.Myxoma were more common in the 4th and 5th decade of life in this study population .Preoperative time delay for operation after hospital admission was 9±2.12days.All the operations were done as an elective procedure rather urgent or emergency procedure. Post operative mortality was around 12.90% among these patients. The causes of high mortality following myxoma operation were Low Output Syndrome, Congestive Heart Failure , Cerebral stroke and septicaemia. \u0000Conclusion: Myxoma operation is common in NICVD. Most of our patients were dealt as a routine procedure. Their features and surgical procedure were similar with a little difference among the neighbouring countries. Our post operative outcome was a little bit worse (12.90% mortality) over the mentioned period. We need to find out the causes and to take care of these patients to reduce mortality in future. \u0000Bangladesh Heart Journal 2018; 33(2) : 85-89","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132699341","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}
Farhana Ahmed, Afzalur Rahman, Mohammad Arifur Rahman, T. Chowdhury, S. H. Chowdhury, Syed Nasir Uddin, A. Islam, Mohsin Ahmed
Background: Acute myocardial infarction (AMI) is one of the leading causes of death and disability all over the world. Primary percutaneous coronary intervention (PCI) is the treatment of choice for patients with acute ST segment elevation myocardial infarction (STEMI). Primary PCI is being increasingly done in our country also. But the factor influencing the outcome of primary PCI in our setting are mostly unknown. The present study was conducted to investigate factors that influencing the short term outcomes of primary PCI. Materials and methods: This prospective observational study was conducted from September 2014 to January 2016in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. 48 patients were selected by purposive sampling. Patients with acute STEMI treated with primary PCI were included in the study based on inclusion and exclusion criteria. Effect of factors including advanced age, male sex, diabetes mellitus, hypertension, dyslipidemia, serum creatinine, left ventricular ejection fraction, anterior myocardial infarction (MI), thrombolysis in myocardial infarction (TIMI) flow, multi vessel disease, angiographic severity score (Leaman score), thrombus aspiration, door to balloon time and total ischemic time on major adverse cardiac events (MACE) i.e. death, post procedural MI, target vessel revascularization (TVR), stroke as well as, on other adverse events like heart failure, cardiogenic shock, major bleeding, significant arrhythmia and stent thrombosis were studied. Results: The overall incidence of MACE was 2.1%, major bleeding 2.1%, heart failure 4.2% and cardiogenic shock 2.1%. In multivariate analysis, the factors independently influencing the adverse short term outcomes (MACE and other adverse events) were diabetes mellitus (odds ratio (OR) 2.55, 95% confidence interval (CI) 1.180 to 4.124, p=0.02), anterior MI (OR 1.48, 95% CI 1.020 to 1.926, p=0.04), total ischaemic time (OR 1.49, 95% CI 1.044 to 2.444, p=0.04), multivessel coronary artery disease (OR 1.77, 95% CI 1.26 to 3.261, p=0.03) and Leaman score (OR 2.5, 95% CI 1.100-4.504, p=.03). Conclusion: According to our finding, diabetes mellitus, anterior myocardial infarction, total ischemic time, multivessel coronary artery disease and high Leaman score are predictors of adverse short term outcomes of primary PCI Bangladesh Heart Journal 2018; 33(2) : 112-120
背景:急性心肌梗死(AMI)是世界范围内导致死亡和残疾的主要原因之一。原发性经皮冠状动脉介入治疗(PCI)是急性ST段抬高型心肌梗死(STEMI)患者的首选治疗方法。原发性PCI在我国也越来越普遍。但在我们的情况下，影响首次PCI治疗结果的因素大多是未知的。本研究旨在探讨影响首次PCI短期疗效的因素。材料与方法:本前瞻性观察性研究于2014年9月至2016年1月在达卡国立心血管疾病研究所(NICVD)心内科进行，采用目的抽样法选取48例患者。根据纳入和排除标准，经首次PCI治疗的急性STEMI患者被纳入研究。高龄、男性、糖尿病、高血压、血脂异常、血清肌酐、左室射血分数、前路心肌梗死(MI)、心肌梗死溶栓(TIMI)血流、多血管疾病、血管造影严重程度评分(Leaman评分)、血栓吸入、门到球囊时间和总缺血时间等因素对主要心脏不良事件(MACE)的影响，即死亡、术后心肌梗死、靶血管重建术(TVR)、研究了卒中以及其他不良事件，如心力衰竭、心源性休克、大出血、明显心律失常和支架血栓形成。结果:MACE总发生率为2.1%，大出血发生率为2.1%，心力衰竭发生率为4.2%，心源性休克发生率为2.1%。在多因素分析中，独立影响短期不良结局(MACE和其他不良事件)的因素有糖尿病(优势比(OR) 2.55, 95%可信区间(CI) 1.180 ~ 4.124, p=0.02)、前路心肌梗死(OR 1.48, 95% CI 1.020 ~ 1.926, p=0.04)、总缺血时间(OR 1.49, 95% CI 1.044 ~ 2.444, p=0.04)、多支冠状动脉疾病(OR 1.77, 95% CI 1.26 ~ 3.261, p=0.03)和Leaman评分(OR 2.5, 95% CI 1.100 ~ 4.504, p=0.03)。结论:根据我们的研究，糖尿病、前路心肌梗死、总缺血时间、多支冠状动脉疾病和高Leaman评分是首次PCI不良短期预后的预测因素;33(2): 112-120
{"title":"Predictors of Short Term Outcomes of Primary Percutaneous Coronary Intervention","authors":"Farhana Ahmed, Afzalur Rahman, Mohammad Arifur Rahman, T. Chowdhury, S. H. Chowdhury, Syed Nasir Uddin, A. Islam, Mohsin Ahmed","doi":"10.3329/BHJ.V33I2.39307","DOIUrl":"https://doi.org/10.3329/BHJ.V33I2.39307","url":null,"abstract":"Background: Acute myocardial infarction (AMI) is one of the leading causes of death and disability all over the world. Primary percutaneous coronary intervention (PCI) is the treatment of choice for patients with acute ST segment elevation myocardial infarction (STEMI). Primary PCI is being increasingly done in our country also. But the factor influencing the outcome of primary PCI in our setting are mostly unknown. The present study was conducted to investigate factors that influencing the short term outcomes of primary PCI. \u0000Materials and methods: This prospective observational study was conducted from September 2014 to January 2016in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. 48 patients were selected by purposive sampling. Patients with acute STEMI treated with primary PCI were included in the study based on inclusion and exclusion criteria. Effect of factors including advanced age, male sex, diabetes mellitus, hypertension, dyslipidemia, serum creatinine, left ventricular ejection fraction, anterior myocardial infarction (MI), thrombolysis in myocardial infarction (TIMI) flow, multi vessel disease, angiographic severity score (Leaman score), thrombus aspiration, door to balloon time and total ischemic time on major adverse cardiac events (MACE) i.e. death, post procedural MI, target vessel revascularization (TVR), stroke as well as, on other adverse events like heart failure, cardiogenic shock, major bleeding, significant arrhythmia and stent thrombosis were studied. \u0000Results: The overall incidence of MACE was 2.1%, major bleeding 2.1%, heart failure 4.2% and cardiogenic shock 2.1%. In multivariate analysis, the factors independently influencing the adverse short term outcomes (MACE and other adverse events) were diabetes mellitus (odds ratio (OR) 2.55, 95% confidence interval (CI) 1.180 to 4.124, p=0.02), anterior MI (OR 1.48, 95% CI 1.020 to 1.926, p=0.04), total ischaemic time (OR 1.49, 95% CI 1.044 to 2.444, p=0.04), multivessel coronary artery disease (OR 1.77, 95% CI 1.26 to 3.261, p=0.03) and Leaman score (OR 2.5, 95% CI 1.100-4.504, p=.03). \u0000Conclusion: According to our finding, diabetes mellitus, anterior myocardial infarction, total ischemic time, multivessel coronary artery disease and high Leaman score are predictors of adverse short term outcomes of primary PCI \u0000Bangladesh Heart Journal 2018; 33(2) : 112-120","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"628 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121986453","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}
M. Islam, Mohsin Ahmed, Mohammad Ali, A. Chowdhury, Khandakar Abu Rubayat
Background: Abnormal glucose metabolism is a predictor of worse outcome after acute coronary syndrome (ACS). However, this parameter is not included in risk prediction scores, including GRACE risk score. We sought to evaluate whether the inclusion of blood glucose at admission in a model with GRACE risk score improves risk stratification. Objectives: To assess whether inclusion of admission blood glucose in a model with GRACE risk score improves risk stratification of ACS patients admitted in a tertiary hospital of Bangladesh. Methods: This cross sectional comparative study was carried out in the department of cardiology, Dhaka Medical College Hospital (DMCH), Dhaka between May 2016 to April 2017. Data were collected from ACS patients admitted at CCU, DMCH who fulfilled inclusion and exclusion criteria. GRACE score was calculated for each patient. The predictive value of death by GRACE score was compared with the predictive value of combined GRACE score + admission blood sugar. Comparison between these results in two groups were done by unpaired t-test, analysis was conducted SPSS-22.0 for windows software. The significance of the results was determined in 95.0% confidence interval and a value of p <0.05 was considered to be statistically significant. Results: A total of 249 cases of ACS patients were selected. Most of the patients belonged to 5th and 6th decades 25.3% vs 37.3% and the mean age was 55.7±11.7 years. Most of the patients were male. High GRACE risk score (≥155) and elevated admission blood sugar (≥11) was found significantly higher in-hospital death whereas only high GRACE risk score (≥155) and normal admission blood sugar (<11) was found non significant regarding in-hospital death. Test of validity showed sensitivity of GRACE risk score regarding in-hospital death was 85.29%, specificity 57.7%, accuracy 61.4%, positive and negative predictive values were 24.2% and 96.1% respectively. The sensitivity of GRACE risk score + admission blood sugar regarding in-hospital death was 85.29%, specificity 62.33%, accuracy 65.46%, positive and negative predictive values were 26.36% and 96.4% respectively. Receiver-operator characteristic (ROC) were constructed using GRACE score and GRACE score + admission blood sugar of the patients with in-hospital death, which showed the sensitivity and specificity of GRACE score for predicting in-hospital death were found to be 79.4% and 58.1%, respectively. Whereas after adding admission blood sugar value to GRACE score both the sensitivity and specificity increased to 82.4% and 58.6% respectively in this new model. Logistic regression analysis of in-hospital mortality with independent risk factors showed GRACE score (≥155) + admission blood sugar (≥11.0 mmol/l) was more significantly associated with in-hospital mortality (P =0.001, OR = 6.675, 95% CI 2.366-13.610). Conclusion: In patients with the whole spectrum of acute coronary syndrome admission blood glucose can add prognostic information to the est
背景:糖代谢异常是急性冠脉综合征(ACS)后预后较差的预测因素。但该参数不计入风险预测评分，包括GRACE风险评分。我们试图评估在GRACE风险评分模型中纳入入院血糖是否能改善风险分层。目的:评估GRACE风险评分模型中纳入入院血糖是否能改善孟加拉国一家三级医院收治的ACS患者的风险分层。方法:于2016年5月至2017年4月在达卡医学院附属医院心内科进行横断面比较研究。数据来自CCU, DMCH住院的ACS患者，符合纳入和排除标准。计算每位患者的GRACE评分。比较GRACE评分对死亡的预测值与GRACE评分+入院血糖的联合预测值。两组间比较采用非配对t检验，采用windows软件SPSS-22.0进行分析。以95.0%的置信区间确定结果的显著性，p <0.05为有统计学意义。结果:共纳入249例ACS患者。患者以5、6岁居多(25.3% vs 37.3%)，平均年龄55.7±11.7岁。大多数患者为男性。高GRACE风险评分(≥155)和入院血糖升高(≥11)对院内死亡有显著性影响，而只有高GRACE风险评分(≥155)和正常入院血糖(<11)对院内死亡无显著性影响。效度检验显示，GRACE风险评分对院内死亡的敏感性为85.29%，特异性为57.7%，准确性为61.4%，阳性预测值为24.2%，阴性预测值为96.1%。GRACE风险评分+入院血糖对院内死亡的敏感性为85.29%，特异性为62.33%，准确性为65.46%，阳性预测值为26.36%，阴性预测值为96.4%。采用GRACE评分和GRACE评分+入院血糖构建接受者-操作者特征(Receiver-operator characteristic, ROC)，结果显示GRACE评分预测院内死亡的敏感性和特异性分别为79.4%和58.1%。而在GRACE评分中加入入院血糖值后，新模型的敏感性和特异性分别提高到82.4%和58.6%。住院死亡率与独立危险因素的Logistic回归分析显示，GRACE评分(≥155)+入院血糖(≥11.0 mmol/l)与住院死亡率的相关性更显著(P =0.001, OR = 6.675, 95% CI 2.366 ~ 13.610)。结论:在全谱急性冠状动脉综合征患者入院时血糖可在GRACE危险评分中增加预后信息。孟加拉国心脏杂志2018;33(2): 94-99
{"title":"Impact of Admission Blood Glucose Added on GRACE Risk Score for All-Cause In-Hospital Mortality in Patients with Acute Coronary Syndrome","authors":"M. Islam, Mohsin Ahmed, Mohammad Ali, A. Chowdhury, Khandakar Abu Rubayat","doi":"10.3329/BHJ.V33I2.39304","DOIUrl":"https://doi.org/10.3329/BHJ.V33I2.39304","url":null,"abstract":"Background: Abnormal glucose metabolism is a predictor of worse outcome after acute coronary syndrome (ACS). However, this parameter is not included in risk prediction scores, including GRACE risk score. We sought to evaluate whether the inclusion of blood glucose at admission in a model with GRACE risk score improves risk stratification. \u0000Objectives: To assess whether inclusion of admission blood glucose in a model with GRACE risk score improves risk stratification of ACS patients admitted in a tertiary hospital of Bangladesh. Methods: This cross sectional comparative study was carried out in the department of cardiology, Dhaka Medical College Hospital (DMCH), Dhaka between May 2016 to April 2017. Data were collected from ACS patients admitted at CCU, DMCH who fulfilled inclusion and exclusion criteria. GRACE score was calculated for each patient. The predictive value of death by GRACE score was compared with the predictive value of combined GRACE score + admission blood sugar. Comparison between these results in two groups were done by unpaired t-test, analysis was conducted SPSS-22.0 for windows software. The significance of the results was determined in 95.0% confidence interval and a value of p <0.05 was considered to be statistically significant. \u0000Results: A total of 249 cases of ACS patients were selected. Most of the patients belonged to 5th and 6th decades 25.3% vs 37.3% and the mean age was 55.7±11.7 years. Most of the patients were male. High GRACE risk score (≥155) and elevated admission blood sugar (≥11) was found significantly higher in-hospital death whereas only high GRACE risk score (≥155) and normal admission blood sugar (<11) was found non significant regarding in-hospital death. Test of validity showed sensitivity of GRACE risk score regarding in-hospital death was 85.29%, specificity 57.7%, accuracy 61.4%, positive and negative predictive values were 24.2% and 96.1% respectively. The sensitivity of GRACE risk score + admission blood sugar regarding in-hospital death was 85.29%, specificity 62.33%, accuracy 65.46%, positive and negative predictive values were 26.36% and 96.4% respectively. Receiver-operator characteristic (ROC) were constructed using GRACE score and GRACE score + admission blood sugar of the patients with in-hospital death, which showed the sensitivity and specificity of GRACE score for predicting in-hospital death were found to be 79.4% and 58.1%, respectively. Whereas after adding admission blood sugar value to GRACE score both the sensitivity and specificity increased to 82.4% and 58.6% respectively in this new model. Logistic regression analysis of in-hospital mortality with independent risk factors showed GRACE score (≥155) + admission blood sugar (≥11.0 mmol/l) was more significantly associated with in-hospital mortality (P =0.001, OR = 6.675, 95% CI 2.366-13.610). \u0000Conclusion: In patients with the whole spectrum of acute coronary syndrome admission blood glucose can add prognostic information to the est","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124762600","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}
A. Islam, S. Munwar, A. H. Bhuiyan, A. Reza, S. Talukder, T. Ahmed, Nighat Islam, A. B. Siddique, Intekhab Yousuf, Z. Rahman, Alam
Background: Percutaneous coronary intervention (PCI) of long lesions by long single stent or overlapping multiple stent might have higher incidences of ISR due to increased metal burden as well as coronary intervention increase cost of hospital stay. Therefore, our primary aim of our study was to evaluate the longterm safety of treating long lesion by a single longer size stent and its follow-up by coronary angiogram and or clinical evaluation at our OPD. Methods: patient who had gone through PCI from the year 2014 to mid Oct 2017 at our center, had longer lesion and were treated by more than 38mmstent were selected and analyzed. Total 255(Male 213: Female 42) patients were enrolled in this study, underwent elective PCI and follow up CAG at on average 1.5 yrs. Total 267 stents were deployed in 255 patients, in some of the patient had double vessel disease to treat. Mean age for both male: female was(55 :56) yrs. Associated Coronary artery disease (CAD) risk factors were Dyslipidemia, Hypertension, Diabetes Mellitus, Positive FH for CAD and Smoking (all male), CKD, Hypothyroidism. Results: Among the study group; 192 (75.3 %) were hypertensive; 189(74.1%) were Dyslipidemic, 126(49.4%) patients were Diabetic, positive FH 74(29.4 %), CKD 8 (3.1%), Hypothyroidism 2 (0.8%) and 104(40.8%) were all male smoker. Common stented territory was, LAD 126(49.4%), RCA 115(45.1%), and LCX 24(9.4%).Among the total patient population, Single vessel stented were 236 (92.5%) and DVD 19 (7.5%). Total 267 stents were deployed, among them 48mm were in total 159 (59.6%); among 40 mm were stented in 61(22.8%) and 38 mm in 47(17.6%) vessels. At an average follow-up period of 1.5 years, all stented territory remain patent without any residual stenosis. Conclusion: We conclude that treating de-novo coronary long lesion by a single longer size stent is safe without any residual stenosis at an average followup period of 1.5 yrs. Thus, to reduce chances of recurrent ISR, hospital re-admission and reduce hospital cost as well. Bangladesh Heart Journal 2018; 33(2) : 106-111
{"title":"Safety of Longer Size Stent in Treating De-Novo Long Coronary Lesion: Outcome at 1.5 Years Follow-Up, A Single Center Experience","authors":"A. Islam, S. Munwar, A. H. Bhuiyan, A. Reza, S. Talukder, T. Ahmed, Nighat Islam, A. B. Siddique, Intekhab Yousuf, Z. Rahman, Alam","doi":"10.3329/bhj.v33i2.39306","DOIUrl":"https://doi.org/10.3329/bhj.v33i2.39306","url":null,"abstract":"Background: Percutaneous coronary intervention (PCI) of long lesions by long single stent or overlapping multiple stent might have higher incidences of ISR due to increased metal burden as well as coronary intervention increase cost of hospital stay. Therefore, our primary aim of our study was to evaluate the longterm safety of treating long lesion by a single longer size stent and its follow-up by coronary angiogram and or clinical evaluation at our OPD. \u0000Methods: patient who had gone through PCI from the year 2014 to mid Oct 2017 at our center, had longer lesion and were treated by more than 38mmstent were selected and analyzed. Total 255(Male 213: Female 42) patients were enrolled in this study, underwent elective PCI and follow up CAG at on average 1.5 yrs. Total 267 stents were deployed in 255 patients, in some of the patient had double vessel disease to treat. Mean age for both male: female was(55 :56) yrs. Associated Coronary artery disease (CAD) risk factors were Dyslipidemia, Hypertension, Diabetes Mellitus, Positive FH for CAD and Smoking (all male), CKD, Hypothyroidism. \u0000Results: Among the study group; 192 (75.3 %) were hypertensive; 189(74.1%) were Dyslipidemic, 126(49.4%) patients were Diabetic, positive FH 74(29.4 %), CKD 8 (3.1%), Hypothyroidism 2 (0.8%) and 104(40.8%) were all male smoker. Common stented territory was, LAD 126(49.4%), RCA 115(45.1%), and LCX 24(9.4%).Among the total patient population, Single vessel stented were 236 (92.5%) and DVD 19 (7.5%). Total 267 stents were deployed, among them 48mm were in total 159 (59.6%); among 40 mm were stented in 61(22.8%) and 38 mm in 47(17.6%) vessels. At an average follow-up period of 1.5 years, all stented territory remain patent without any residual stenosis. \u0000Conclusion: We conclude that treating de-novo coronary long lesion by a single longer size stent is safe without any residual stenosis at an average followup period of 1.5 yrs. Thus, to reduce chances of recurrent ISR, hospital re-admission and reduce hospital cost as well. \u0000Bangladesh Heart Journal 2018; 33(2) : 106-111","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125141912","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}
Mohsin Ahmed, M. Islam, Mohammad Arifur Rahman, Khandaker Abu Rubaiyat, Cm Khudrate E Khuda, K. A. Ferdous, B. Das, S. K. Linda
Background: Recent evidence suggests that inflammatory markers and poor glycemic control are significantly associated with the development of cardiovascular complications. The purpose of this study was to determine the association between inflammatory marker (CRP) and glycemic status (HbA1c) in ischemic heart disease patients. Method: This cross sectional study was performed on 668 patients of ischemic heart disease in the Department of Cardiology, Dhaka Medical College Hospital, Dhaka, who underwent Coronary angiogram from January 2017 to December 2017. CRP value were divided into normal (<6 mg/L), borderline (6-10 mg/L) and high (>10 mg/L) and HbA1c was divided <6.5% and ≥6.5%. After performed Coronary angiography the extent of disease was divided into insignificant CAD of (<50% stenosis), significant CAD considered as >50% stenosis and single vessel, double vessel, triple vessel CAD and normal coronaries. The relationship between CRP with HbA1c was analyzed by Chi square test. ANOVA test was used to analyze the continuous variables, shown with mean and standard deviation. Pearson’s correlation coefficient was used to test the relationship between CRP and HbA1c in CAD patients. p value <0.05 was considered as statistically significant. Result: Most (65.0%) of the patients belonged to age 41-60 years. The mean age was found 51.4±10.7 years. Majority (82.3%) of patients were male. Among risk factors, highest (40.0%) patients had hypertension followed by 209 (31.3%) diabetes mellitus and 204 (30.5%) smoker. Positive correlation was found (r=0.220, p= 0.001) between HbA1c with CRP in CAD patients. High CRP was found 138(38.4%) in <6.5% HbA1c and 187(60.5%) in ≥6.5 percent HbA1c. The difference was statistically significant (p<0.05). Multi variable logistic regression was found high HbA1c, high CRP and diabetes mellitus were statistically significant (p<0.05) in severe CAD (Double and triple vessel) patient. Conclusion: Positive correlation was found between serum levels of CRP and HbA1c in CAD patients. Thus, aiming at good glycemic control and estimation of serum CRP levels will possibly be of help in planning early intervention, thereby preventing further complications which in turn may help preserve cardiac functions in ischemic heart disease patients. Bangladesh Heart Journal 2018; 33(2) : 100-105
{"title":"Correlation between Inflammatory Marker and Glycemic Control in Patients with Ischemic Heart Disease","authors":"Mohsin Ahmed, M. Islam, Mohammad Arifur Rahman, Khandaker Abu Rubaiyat, Cm Khudrate E Khuda, K. A. Ferdous, B. Das, S. K. Linda","doi":"10.3329/BHJ.V33I2.39305","DOIUrl":"https://doi.org/10.3329/BHJ.V33I2.39305","url":null,"abstract":"Background: Recent evidence suggests that inflammatory markers and poor glycemic control are significantly associated with the development of cardiovascular complications. The purpose of this study was to determine the association between inflammatory marker (CRP) and glycemic status (HbA1c) in ischemic heart disease patients. \u0000Method: This cross sectional study was performed on 668 patients of ischemic heart disease in the Department of Cardiology, Dhaka Medical College Hospital, Dhaka, who underwent Coronary angiogram from January 2017 to December 2017. CRP value were divided into normal (<6 mg/L), borderline (6-10 mg/L) and high (>10 mg/L) and HbA1c was divided <6.5% and ≥6.5%. After performed Coronary angiography the extent of disease was divided into insignificant CAD of (<50% stenosis), significant CAD considered as >50% stenosis and single vessel, double vessel, triple vessel CAD and normal coronaries. The relationship between CRP with HbA1c was analyzed by Chi square test. ANOVA test was used to analyze the continuous variables, shown with mean and standard deviation. Pearson’s correlation coefficient was used to test the relationship between CRP and HbA1c in CAD patients. p value <0.05 was considered as statistically significant. \u0000Result: Most (65.0%) of the patients belonged to age 41-60 years. The mean age was found 51.4±10.7 years. Majority (82.3%) of patients were male. Among risk factors, highest (40.0%) patients had hypertension followed by 209 (31.3%) diabetes mellitus and 204 (30.5%) smoker. Positive correlation was found (r=0.220, p= 0.001) between HbA1c with CRP in CAD patients. High CRP was found 138(38.4%) in <6.5% HbA1c and 187(60.5%) in ≥6.5 percent HbA1c. The difference was statistically significant (p<0.05). Multi variable logistic regression was found high HbA1c, high CRP and diabetes mellitus were statistically significant (p<0.05) in severe CAD (Double and triple vessel) patient. \u0000Conclusion: Positive correlation was found between serum levels of CRP and HbA1c in CAD patients. Thus, aiming at good glycemic control and estimation of serum CRP levels will possibly be of help in planning early intervention, thereby preventing further complications which in turn may help preserve cardiac functions in ischemic heart disease patients. \u0000Bangladesh Heart Journal 2018; 33(2) : 100-105","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130171279","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}
Afzalur Rahman, Mohammad Arifur Rahman, Farhana Ahmed, R. Sultana, N. Khan
Introduction: The burden of CAD is increasing at a greater rate in South Asia than in any other region globally. Among them acute ST elevation myocardial infarction (STEMI) is one of the leading causes of death and disability. Major aspect of treatment of acute STEMI is reperfusion of the infarct related artery. Delay in reperfusion is associated with higher mortality and morbidity rates. While primary percutaneous coronary intervention (PCI) is the preferred mode of reperfusion, only few patients can get this form of reperfusion within recommended timelines. On the other hand, thrombolysis is easily available, economical and evaluated in several clinical studies. Thrombolysis is an important reperfusion strategy, especially when primary PCI cannot be offered to STEMI patients, with a time dependent fashion. Methods: This randomized controlled trial was conducted in the department of Cardiology of National Institute of Cardiovascular Diseases since January 2016 to June 2018. Objective of the study was to find out the outcomes of acute STEMI patients after getting on-shelve or purchased Streptokinase (STK). Initially there was no free supply of STK in our hospital as it is an expensive drug, later on fund was arranged and STK was made available at free of cost by the hospital authority. Total 300 patients fulfilling inclusion and exclusion criteria were included in the study. Group I: 150 patients received on-shelf STK when it was made free by the authority and Group II: 150 patients received purchased STK when it was not available at free of cost. Study populations were analyzed for LVF, Cardiogenic shock, MACE (re-infarction, stroke and death) and duration of hospital stay. Results: The mean age of the study population in group I and II were 53.88 ± 14.51 vs. 57.18 ± 15.28 years (p= 0.46). Mean door to injection time in group I and II were 25.51 ± 7.9 vs. 70.36 ± 16.6 minutes (p=<0.001). ST segment resolution was significantly higher in on-shelf STK group then purchased group which were 109 (72.7%) vs. 92 (61.3%), p=0.03. Considering the in-hospital outcome we found that in group I and group II LVF (killip III/IV) was 10 (6.7%) vs. 23 (15.3%) , Cardiogenic shock was 11 (7.3%) vs. 24(16%) , re-infarction was 9(6%) vs. 13 (8.7%) , Stroke was 6 (4%) vs. 8 (5.3%) and death was 12 (8%) vs. 23(15.3%). Among them LVF (killip III/IV), Cardiogenic shock and Death were significantly higher in group II (p=0.02, 0.01 and 0.04 respectively). Major adverse cardiac events (MACE) included re-infarction, Stroke and death, were significantly higher in group II [27 (18%) vs. 44(29.3), p= 0.02]. Mean hospital stay was significantly higher in group II (6.05 ± 1.81) then group I (5.33±1.26), (p=<0.001). Multivariate logistic regression analysis showed hypertension (p=.025) and door to injection time (p=.002) were statistically significant predictors for in-hospital major advance cardiac events (re-infarction, stroke and death) after streptokinase therapy. Conclusi
{"title":"On-shelf Streptokinse EnsuRes More Favorable In-hospital Outcome after Acute STEMI (OSTRIC trial) - A Single Centre Randomized Controlled Trial","authors":"Afzalur Rahman, Mohammad Arifur Rahman, Farhana Ahmed, R. Sultana, N. Khan","doi":"10.3329/bhj.v33i2.39309","DOIUrl":"https://doi.org/10.3329/bhj.v33i2.39309","url":null,"abstract":"Introduction: The burden of CAD is increasing at a greater rate in South Asia than in any other region globally. Among them acute ST elevation myocardial infarction (STEMI) is one of the leading causes of death and disability. Major aspect of treatment of acute STEMI is reperfusion of the infarct related artery. Delay in reperfusion is associated with higher mortality and morbidity rates. While primary percutaneous coronary intervention (PCI) is the preferred mode of reperfusion, only few patients can get this form of reperfusion within recommended timelines. On the other hand, thrombolysis is easily available, economical and evaluated in several clinical studies. Thrombolysis is an important reperfusion strategy, especially when primary PCI cannot be offered to STEMI patients, with a time dependent fashion. \u0000Methods: This randomized controlled trial was conducted in the department of Cardiology of National Institute of Cardiovascular Diseases since January 2016 to June 2018. Objective of the study was to find out the outcomes of acute STEMI patients after getting on-shelve or purchased Streptokinase (STK). Initially there was no free supply of STK in our hospital as it is an expensive drug, later on fund was arranged and STK was made available at free of cost by the hospital authority. Total 300 patients fulfilling inclusion and exclusion criteria were included in the study. Group I: 150 patients received on-shelf STK when it was made free by the authority and Group II: 150 patients received purchased STK when it was not available at free of cost. Study populations were analyzed for LVF, Cardiogenic shock, MACE (re-infarction, stroke and death) and duration of hospital stay. \u0000Results: The mean age of the study population in group I and II were 53.88 ± 14.51 vs. 57.18 ± 15.28 years (p= 0.46). Mean door to injection time in group I and II were 25.51 ± 7.9 vs. 70.36 ± 16.6 minutes (p=<0.001). ST segment resolution was significantly higher in on-shelf STK group then purchased group which were 109 (72.7%) vs. 92 (61.3%), p=0.03. Considering the in-hospital outcome we found that in group I and group II LVF (killip III/IV) was 10 (6.7%) vs. 23 (15.3%) , Cardiogenic shock was 11 (7.3%) vs. 24(16%) , re-infarction was 9(6%) vs. 13 (8.7%) , Stroke was 6 (4%) vs. 8 (5.3%) and death was 12 (8%) vs. 23(15.3%). Among them LVF (killip III/IV), Cardiogenic shock and Death were significantly higher in group II (p=0.02, 0.01 and 0.04 respectively). Major adverse cardiac events (MACE) included re-infarction, Stroke and death, were significantly higher in group II [27 (18%) vs. 44(29.3), p= 0.02]. Mean hospital stay was significantly higher in group II (6.05 ± 1.81) then group I (5.33±1.26), (p=<0.001). Multivariate logistic regression analysis showed hypertension (p=.025) and door to injection time (p=.002) were statistically significant predictors for in-hospital major advance cardiac events (re-infarction, stroke and death) after streptokinase therapy. \u0000Conclusi","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126714835","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}
S. Russel, Jubayer Ahmad, Raju Ahmed, J. Uddin, Suman Nazmul Hosain
Native arterio-venous fistula (AVF) are the preferred mode of repeated vascular access for the chronic renal failure patients surviving on hemodialysis because of their easy accessibility, good long term patency, low complication rate and cost-effectiveness. Creation of a fistula between the radial or brachial artery and a suitable adjacent vein is the most commonly practiced option. However the major upper arm veins of the CKD patients are often found thrombosed, cord like and not suitable for AV anastomosis. A 48 years old male patient of chronic kidney disease with a permanent catheter placed in the right subclavian vein was referred to create an AV fistula. On exploration none of the upper limb veins was found suitable for fistula formation. The proximal part of the left GSV was harvested from patient’s left upper thigh and was used to make a connection between left brachial artery at cubital fossa and the left axillary vein. To avoid over flooding of the limb vasculature, partial banding of the left axillary vein was done distal to this anastomosis. When all options in both upper limbs are exhausted, autologous great saphenous grafts may be a very useful tool for the surgeons in creating upper limb AV fistulas in difficult situations Bangladesh Heart Journal 2018; 33(2) : 134-137
{"title":"Brachio- Axillary Translocation Fistula with Reverse Saphenous Venous Graft: a New Hope for the Patients of End stage Renal Disease","authors":"S. Russel, Jubayer Ahmad, Raju Ahmed, J. Uddin, Suman Nazmul Hosain","doi":"10.3329/BHJ.V33I2.39310","DOIUrl":"https://doi.org/10.3329/BHJ.V33I2.39310","url":null,"abstract":"Native arterio-venous fistula (AVF) are the preferred mode of repeated vascular access for the chronic renal failure patients surviving on hemodialysis because of their easy accessibility, good long term patency, low complication rate and cost-effectiveness. Creation of a fistula between the radial or brachial artery and a suitable adjacent vein is the most commonly practiced option. However the major upper arm veins of the CKD patients are often found thrombosed, cord like and not suitable for AV anastomosis. A 48 years old male patient of chronic kidney disease with a permanent catheter placed in the right subclavian vein was referred to create an AV fistula. On exploration none of the upper limb veins was found suitable for fistula formation. The proximal part of the left GSV was harvested from patient’s left upper thigh and was used to make a connection between left brachial artery at cubital fossa and the left axillary vein. To avoid over flooding of the limb vasculature, partial banding of the left axillary vein was done distal to this anastomosis. When all options in both upper limbs are exhausted, autologous great saphenous grafts may be a very useful tool for the surgeons in creating upper limb AV fistulas in difficult situations \u0000Bangladesh Heart Journal 2018; 33(2) : 134-137","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128411286","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}
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