K. Ashiq, Sana Ashiq, N. Shehzadi, K. Hussain, M. T. Khan
Hypertension or high blood pressure (BP) is a long-term ailment in which blood pressure in the arteries raises persistently. Blood pressure can be determined using two methods, systolic pressure which is the uppermost pressure and diastolic pressure which is the lowermost blood pressure in the arterial system. It is estimated that worldwide around 1.13 billion persons are suffering from hypertension. In addition, the World Health Organization (WHO) has reported that 13% of all deaths in the world are caused by hypertension. Furthermore, they set a target to reduce its frequency by 25% from the year 2010 to 2025.1,2 Rheumatoid arthritis (RA) is a systemic autoimmune disease that leads to inflammation of the joints and pain. Approximately 1% of the global population is diagnosed with this disease. Rheumatoid arthritis can be associated with multiple comorbidities that can reduce a patient's quality of life (QoL), upturn the economic burden of the disease, and may increase the rate of mortality. Cardiovascular comorbidities are quite common in patients with rheumatoid arthritis. Cardiovascular comorbidity is estimated to be about 1.5 times more frequent in patients with rheumatoid arthritis than in healthy people. Many studies have suggested that of all cardiovascular disorders, hypertension is the most important and changeable risk factor in subjects suffering from rheumatoid arthritis. Based on a pool of 115,867 insurance claims, about 76% of rheumatoid arthritis patients in America were diagnosed with hypertension. These results are similar to studies conducted in Europe and Canada that have shown a higher incidence of hypertension in patients with rheumatoid arthritis compared to the normal group. It is unknown why patients with rheumatoid arthritis pose such a high risk for hypertension. Reduced physical activity, obesity, systemic inflammation, and medications used to treat rheumatoid arthritis can increase the risk of high blood pressure.3 Around 0.55% of the urban population in northern Pakistan suffers from rheumatoid arthritis, while the incidence rate is close to 0.14% in southern Pakistan.4 There are many reasons why people with rheumatoid arthritis have high blood pressure. Chronic inflammation in rheumatoid arthritis results in increased rigidity of arteries leading to increase systolic blood pressure. The first presumed link between low-grade systemic inflammation and hypertension has been identified in previous studies conducted on the general population. In rheumatoid arthritis, elevated levels of C-reactive protein (CRP) increase the likelihood of developing high blood pressure. Several mechanisms may be implicated in the development of hypertension with a high concentration of C-reactive protein. For example, nitric oxide synthesis may be reduced because of the increased concentration of the C-reactive protein that will cause vasoconstriction, platelet activation and thrombosis. Additionally, increased expression of the type 1 ang
{"title":"PREVALENCE AND CONTROL OF THE HYPERTENSION IN PATIENTS SUFFERING FROM RHEUMATOID ARTHRITIS","authors":"K. Ashiq, Sana Ashiq, N. Shehzadi, K. Hussain, M. T. Khan","doi":"10.47144/phj.v55i4.2352","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2352","url":null,"abstract":"Hypertension or high blood pressure (BP) is a long-term ailment in which blood pressure in the arteries raises persistently. Blood pressure can be determined using two methods, systolic pressure which is the uppermost pressure and diastolic pressure which is the lowermost blood pressure in the arterial system. It is estimated that worldwide around 1.13 billion persons are suffering from hypertension. In addition, the World Health Organization (WHO) has reported that 13% of all deaths in the world are caused by hypertension. Furthermore, they set a target to reduce its frequency by 25% from the year 2010 to 2025.1,2\u0000Rheumatoid arthritis (RA) is a systemic autoimmune disease that leads to inflammation of the joints and pain. Approximately 1% of the global population is diagnosed with this disease. Rheumatoid arthritis can be associated with multiple comorbidities that can reduce a patient's quality of life (QoL), upturn the economic burden of the disease, and may increase the rate of mortality. Cardiovascular comorbidities are quite common in patients with rheumatoid arthritis. Cardiovascular comorbidity is estimated to be about 1.5 times more frequent in patients with rheumatoid arthritis than in healthy people. Many studies have suggested that of all cardiovascular disorders, hypertension is the most important and changeable risk factor in subjects suffering from rheumatoid arthritis. Based on a pool of 115,867 insurance claims, about 76% of rheumatoid arthritis patients in America were diagnosed with hypertension. These results are similar to studies conducted in Europe and Canada that have shown a higher incidence of hypertension in patients with rheumatoid arthritis compared to the normal group. It is unknown why patients with rheumatoid arthritis pose such a high risk for hypertension. Reduced physical activity, obesity, systemic inflammation, and medications used to treat rheumatoid arthritis can increase the risk of high blood pressure.3 Around 0.55% of the urban population in northern Pakistan suffers from rheumatoid arthritis, while the incidence rate is close to 0.14% in southern Pakistan.4\u0000There are many reasons why people with rheumatoid arthritis have high blood pressure. Chronic inflammation in rheumatoid arthritis results in increased rigidity of arteries leading to increase systolic blood pressure. The first presumed link between low-grade systemic inflammation and hypertension has been identified in previous studies conducted on the general population. In rheumatoid arthritis, elevated levels of C-reactive protein (CRP) increase the likelihood of developing high blood pressure. Several mechanisms may be implicated in the development of hypertension with a high concentration of C-reactive protein. For example, nitric oxide synthesis may be reduced because of the increased concentration of the C-reactive protein that will cause vasoconstriction, platelet activation and thrombosis. Additionally, increased expression of the type 1 ang","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46188241","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}
Motahare Haghighatkhah, Zeinab Ghorbani, Azin Vakilpour, Elahe Pouryousefi, H. A. Balou, M. Roshan
Objectives: The current cross-sectional study intended to provide a comparative evaluation of nutritional status in the intensive care unit (ICU)-hospitalized patients according to the reasons for admission. Methodology: A total of 258 patients hospitalized for >24-hour in the ICU between February 2020- July 2021 were included. The subjects were categorized into five categories: burned injury (n=27), COVID-19 or other respiratory disorders (n=64), post coronary artery bypass graft surgery (post-CABG) (n=50), trauma (n=57), and miscellaneous causes (n=60). A modified Nutrition Risk in Critically Ill (mNUTRIC) score was applied to explore the nutritional status of the patients. Results: On average, the patients were 58± 16 years old that 46% (n=119) of them were females. The mean± SD of mNUTRIC score among patients with burned 2±1 and COVID-19 or other respiratory disorders 2±1 tended to be significantly lower than the others, including post-CABG 3±0 and patients with miscellaneous causes 3±2 (p-value=0.001). According to mNUTRIC score classifications, the majority of those who were transferred to ICU with burn or COVID-19 or other respiratory disorders were at low nutritional risk (mNUTRIC score:0-<3) (66.70%, and 67.20%, respectively); whereas relatively all post CABG subjects were at intermediate nutritional risk (mNUTRIC score:3-<5) (n= 48, 96.00%). A greater proportion of subjects in the miscellaneous category (n=12, 20.00%) were at high nutritional risk (mNUTRIC score:5-9) (p-value <0.001). Conclusion: It was revealed that approximately all post CABG and those admitted to ICU with miscellaneous causes were at a higher risk for impaired nutritional status and may require more in-depth evaluation for providing earlier nutritional support.
{"title":"COMPARATIVE EVALUATION OF NUTRITIONAL STATUS SCORE IN ICU-HOSPITALIZED PATIENTS INDICATES HIGHER NUTRITIONAL RISK AMONG POST CABG SUBJECTS: A CROSS-SECTIONAL STUDY IN THE NORTH OF IRAN","authors":"Motahare Haghighatkhah, Zeinab Ghorbani, Azin Vakilpour, Elahe Pouryousefi, H. A. Balou, M. Roshan","doi":"10.47144/phj.v55i4.2265","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2265","url":null,"abstract":"Objectives: The current cross-sectional study intended to provide a comparative evaluation of nutritional status in the intensive care unit (ICU)-hospitalized patients according to the reasons for admission.\u0000Methodology: A total of 258 patients hospitalized for >24-hour in the ICU between February 2020- July 2021 were included. The subjects were categorized into five categories: burned injury (n=27), COVID-19 or other respiratory disorders (n=64), post coronary artery bypass graft surgery (post-CABG) (n=50), trauma (n=57), and miscellaneous causes (n=60). A modified Nutrition Risk in Critically Ill (mNUTRIC) score was applied to explore the nutritional status of the patients.\u0000Results: On average, the patients were 58± 16 years old that 46% (n=119) of them were females. The mean± SD of mNUTRIC score among patients with burned 2±1 and COVID-19 or other respiratory disorders 2±1 tended to be significantly lower than the others, including post-CABG 3±0 and patients with miscellaneous causes 3±2 (p-value=0.001). According to mNUTRIC score classifications, the majority of those who were transferred to ICU with burn or COVID-19 or other respiratory disorders were at low nutritional risk (mNUTRIC score:0-<3) (66.70%, and 67.20%, respectively); whereas relatively all post CABG subjects were at intermediate nutritional risk (mNUTRIC score:3-<5) (n= 48, 96.00%). A greater proportion of subjects in the miscellaneous category (n=12, 20.00%) were at high nutritional risk (mNUTRIC score:5-9) (p-value <0.001).\u0000Conclusion: It was revealed that approximately all post CABG and those admitted to ICU with miscellaneous causes were at a higher risk for impaired nutritional status and may require more in-depth evaluation for providing earlier nutritional support.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48593929","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}
Syed Muhammad Ashraf Jahangeer, Areeba Ikram, Anmol Anmol, M. Lashari, Kainat Kataria, E. Turk, M. Rehan
Objectives: Cardiovascular disease (CVDs) is the leading cause of deaths globally. Apart from traditional risks, multiple indigenous factors are implicated to impact disease courses. Lifestyle factors distinct to South Asians may predispose to disease or serve a protective effect. Our study objective was to determine the Relationship of lifestyle and dietary habits of South-east Asian (Pakistani) population with cardiovascular diseases. Methodology: A case-control study was conducted from April to October 2021 in a two-thousand bedded university teaching hospital in Karachi, Pakistan. Out of 400 participants, 189 were cases with a documented cardiovascular event and 211 were controls. Participants >18 years were included whereas pregnant females and patients with congenital heart defects were excluded. A structured questionnaire was designed and implemented, and anthropometrics were recorded. Chi-square test, independent sample t-test and multivariate analysis were utilized via SPSSv23. P-value <0.05 was considered significant. Results: From 400 participants, 189 cases and 211 controls were identified. 53.4% of the people consuming open spices had CVDs while 46.6% did not. While only 37% of people using home cooked spices had CVDs with an OR= 0.51(0.3-0.84, 95% CI, p=0.08). Our results showed an inverse or no relationship of high BMI with CVDs. No statistically significant results were observed of diabetes and hypertension with CVDs. Conclusion: Based on our results, home grounded condiments have a protective effects on CVD than open spices. With reference to CVD, poor lifestyle habits and anthropometric profiles of our controls indicate a need for urgent preventive measures at population level.
{"title":"RELATIONSHIP OF LIFESTYLE AND DIETARY HABITS OF SOUTH-EAST ASIAN (PAKISTANI) POPULATION WITH CARDIOVASCULAR DISEASES: A CASE-CONTROL STUDY","authors":"Syed Muhammad Ashraf Jahangeer, Areeba Ikram, Anmol Anmol, M. Lashari, Kainat Kataria, E. Turk, M. Rehan","doi":"10.47144/phj.v55i4.2321","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2321","url":null,"abstract":"Objectives: Cardiovascular disease (CVDs) is the leading cause of deaths globally. Apart from traditional risks, multiple indigenous factors are implicated to impact disease courses. Lifestyle factors distinct to South Asians may predispose to disease or serve a protective effect. Our study objective was to determine the Relationship of lifestyle and dietary habits of South-east Asian (Pakistani) population with cardiovascular diseases.\u0000Methodology: A case-control study was conducted from April to October 2021 in a two-thousand bedded university teaching hospital in Karachi, Pakistan. Out of 400 participants, 189 were cases with a documented cardiovascular event and 211 were controls. Participants >18 years were included whereas pregnant females and patients with congenital heart defects were excluded. A structured questionnaire was designed and implemented, and anthropometrics were recorded. Chi-square test, independent sample t-test and multivariate analysis were utilized via SPSSv23. P-value <0.05 was considered significant.\u0000Results: From 400 participants, 189 cases and 211 controls were identified. 53.4% of the people consuming open spices had CVDs while 46.6% did not. While only 37% of people using home cooked spices had CVDs with an OR= 0.51(0.3-0.84, 95% CI, p=0.08). Our results showed an inverse or no relationship of high BMI with CVDs. No statistically significant results were observed of diabetes and hypertension with CVDs.\u0000Conclusion: Based on our results, home grounded condiments have a protective effects on CVD than open spices. With reference to CVD, poor lifestyle habits and anthropometric profiles of our controls indicate a need for urgent preventive measures at population level.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48558877","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}
Ghulam Abbas Seikh, Faisal Ahmed, A. A. Shah, Syed Dilbahar Ali Shah Asad, Fareheen Ashfaq, Shabnam Shabnam, M. Lashari
Objectives: To compare angiographic findings between diabetic and non-diabetic patients with acute coronary syndrome (ACS) along with feasibility of P2Y12 inhibitors withholding approach for urgent coronary artery bypass grafting (CABG) in diabetic (DM) patients with severe lesions. Methodology: Consecutive ACS patients were included. P2Y12 inhibitors was hold in a certain number of diabetic patients with either left main (LM) or multi-vessel disease (MVD) on baseline angiogram, at the discretion of primary physician. Angiographic diseases severity was compared between diabetic and non-diabetics. The clinical management and outcomes of diabetic patients were further compared based on the deferred P2Y12 inhibitors approach. Results: Out of 205 patients, 149 were males and 40.9% were diabetic. Involved vessel was LM in 19.8% vs. 16.6%; p=0.566, left anterior descending artery (LAD) in 62.8% vs. 39.3%; p=0.001, and right coronary artery in 27.3% vs. 45.2%; p=0.008 with MVD in 42.1% vs. 28.6%, p=0.047 of the diabetic and non-diabetic patients, respectively. P2Y12 inhibitors was hold in 59 diabetic patients who undergone urgent CABG with hospital stay of <5 days. In remaining 62 diabetic patients, 50 undergo coronary intervention and 12 undergo delayed CABG with hospital stay of >5 days due to P2Y12 administration. Conclusion: The presence of DM showed a significant association with the involvement of the LAD artery. Most participants showed presence of MVD. By holding P2Y12 inhibitors reduces the perioperative bleeding and hospital stay.
{"title":"APPROACH OF WITHHOLDING P2Y12 INHIBITORS FOR URGENT CORONARY ARTERY BYPASS GRAFTING IN DIABETIC PATIENTS WITH ACUTE CORONARY SYNDROME","authors":"Ghulam Abbas Seikh, Faisal Ahmed, A. A. Shah, Syed Dilbahar Ali Shah Asad, Fareheen Ashfaq, Shabnam Shabnam, M. Lashari","doi":"10.47144/phj.v55i4.2282","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2282","url":null,"abstract":"Objectives: To compare angiographic findings between diabetic and non-diabetic patients with acute coronary syndrome (ACS) along with feasibility of P2Y12 inhibitors withholding approach for urgent coronary artery bypass grafting (CABG) in diabetic (DM) patients with severe lesions.\u0000Methodology: Consecutive ACS patients were included. P2Y12 inhibitors was hold in a certain number of diabetic patients with either left main (LM) or multi-vessel disease (MVD) on baseline angiogram, at the discretion of primary physician. Angiographic diseases severity was compared between diabetic and non-diabetics. The clinical management and outcomes of diabetic patients were further compared based on the deferred P2Y12 inhibitors approach.\u0000Results: Out of 205 patients, 149 were males and 40.9% were diabetic. Involved vessel was LM in 19.8% vs. 16.6%; p=0.566, left anterior descending artery (LAD) in 62.8% vs. 39.3%; p=0.001, and right coronary artery in 27.3% vs. 45.2%; p=0.008 with MVD in 42.1% vs. 28.6%, p=0.047 of the diabetic and non-diabetic patients, respectively. P2Y12 inhibitors was hold in 59 diabetic patients who undergone urgent CABG with hospital stay of <5 days. In remaining 62 diabetic patients, 50 undergo coronary intervention and 12 undergo delayed CABG with hospital stay of >5 days due to P2Y12 administration.\u0000Conclusion: The presence of DM showed a significant association with the involvement of the LAD artery. Most participants showed presence of MVD. By holding P2Y12 inhibitors reduces the perioperative bleeding and hospital stay.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48276924","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 : 2022-11-17DOI: 10.47144/phj.v55isupplement1.2419
Umer Shafiq, Muhammad Abdul Wahab, S. Rahman
Objectives: Cardiovascular disease (CVD) is considered as one of the important priorities in the health systems of all countries. Approximately 550,000 first episodes and 200,000 recurrent episodes of acute myocardial infarction occur annually worldwide. Globally, ischemic heart disease has become the leading contributor to the burden of disease as assessed on the basis of disability-adjusted life-years. To determine the efficacy of accelerated streptokinase in patients with acute ST elevation myocardial infarction. Methodology: This Descriptive study was done in the Department of Cardiology, Hayatabad Medical Complex Peshawar from August 2020 to February 2021. Total 144 patients were observed. All patients were subjected to SK in a dose of 1.5million units over 60 minutes. All patients were under strict observation and a repeat ECG was performed to determine the efficacy of accelerated SK. Results: Our study shows that among 144 patients mean age and standard deviation was 61± 8.19. 88(61%) patients were male and 56(39%) patients were female. More over accelerated streptokinase was effective in 92(64%) patients and was not effective in 52(36%) patients. Conclusion: The accelerated SK infusion regimen of 1.5 MU in 20 min is safe and well tolerated with significantly faster and higher clinical reperfusion rates, more preserved LV systolic function, less atrial and ventricular sustained arrhythmias, and less in-hospital and 1 year mortality rates in acute STEMI.
目标:心血管疾病(CVD)被认为是所有国家卫生系统的重要优先事项之一。全世界每年大约有55万例急性心肌梗死首次发作和20万例急性心肌梗死复发。在全球范围内，根据残疾调整生命年评估，缺血性心脏病已成为造成疾病负担的主要因素。目的:探讨加速链激酶治疗急性ST段抬高型心肌梗死的疗效。方法:本描述性研究于2020年8月至2021年2月在白沙瓦Hayatabad医疗中心心脏病科完成。共观察144例患者。所有患者在60分钟内接受150万单位剂量的SK。结果:144例患者的平均年龄和标准差为61±8.19。男性88例(61%)，女性56例(39%)。过度加速的链激酶在92例(64%)患者中有效，52例(36%)患者无效。结论:20 min 1.5 MU的SK加速输注方案安全且耐受性良好，临床再灌注率更快、更高，左室收缩功能更完整，房性和室性持续性心律失常更少，急性STEMI住院死亡率和1年死亡率更低。
{"title":"EFFICACY OF ACCELERATED STREPTOKINASE INFUSION IN THE TREATMENT OF ST ELEVATION MYOCARDIAL INFARCTION","authors":"Umer Shafiq, Muhammad Abdul Wahab, S. Rahman","doi":"10.47144/phj.v55isupplement1.2419","DOIUrl":"https://doi.org/10.47144/phj.v55isupplement1.2419","url":null,"abstract":"Objectives: Cardiovascular disease (CVD) is considered as one of the important priorities in the health systems of all countries. Approximately 550,000 first episodes and 200,000 recurrent episodes of acute myocardial infarction occur annually worldwide. Globally, ischemic heart disease has become the leading contributor to the burden of disease as assessed on the basis of disability-adjusted life-years. To determine the efficacy of accelerated streptokinase in patients with acute ST elevation myocardial infarction. \u0000Methodology: This Descriptive study was done in the Department of Cardiology, Hayatabad Medical Complex Peshawar from August 2020 to February 2021. Total 144 patients were observed. All patients were subjected to SK in a dose of 1.5million units over 60 minutes. All patients were under strict observation and a repeat ECG was performed to determine the efficacy of accelerated SK. \u0000Results: Our study shows that among 144 patients mean age and standard deviation was 61± 8.19. 88(61%) patients were male and 56(39%) patients were female. More over accelerated streptokinase was effective in 92(64%) patients and was not effective in 52(36%) patients. \u0000Conclusion: The accelerated SK infusion regimen of 1.5 MU in 20 min is safe and well tolerated with significantly faster and higher clinical reperfusion rates, more preserved LV systolic function, less atrial and ventricular sustained arrhythmias, and less in-hospital and 1 year mortality rates in acute STEMI.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46168959","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 : 2022-11-17DOI: 10.47144/phj.v55isupplement1.2418
M. Siddiqui, Rajesh Kumar, J. Sial, M. Karim
Objectives: Main objective for this study to unfold this controversy in South Asian population in terms of clinical, angiographic parameters and its in-hospital outcomes. Methodology: In this study, we included 1756 consecutive patients diagnosed with STEMI undergoing primary PCI. Patients were classified into smokers and nonsmokers. Comparison was done on the basis of baseline characteristics, clinical presentation, angiographic features and in-hospital mortality between two groups. Multivariable logistic regression analysis was performed to evaluate the paradoxical role of smoking. Results: Smokers were younger (53.78±11.16 years vs. 56.43±11.17 years; p<0.001) and more frequently male (98.7% vs. 69.9%; p<0.001), and had less diabetes (19.6% vs. 44.8%; p<0.001) and hypertension (38.5% vs. 64.9%; p<0.001). Smokers presented less frequently in Killip III (5.6% vs. 8.1%; p<0.001) and Killip IV (2.5% vs. 4.8%; p<0.001) in smokers group. Smokers mostly had single vessel disease (41.7% vs. 34.4%; p=0.013) whereas non-smokers had complex disease and frequently presented with total occlusion of the culprit vessel (64.6% vs. 58.8%; p=0.040). Complication such as slow flow/no-flow (24.3% vs. 33.2%; p<0.001) and cardiogenic shock (2.3% vs. 4.6%; p<0.001) were also seen less often among smokers. Smokers has significantly lesser mortality (1.8% vs. 4.3%; p=0.009) compared to non-smokers with an odds ratio (OR) of 0.41 [95% CI: 0.21-0.82, p=0.011], however, adjusted OR on multivariable analysis was 0.67 [95% CI: 0.31-1.41, p=0.290]. Independent predictors of mortality were found to be history of CVA/stroke, pre-procedure LVEDP, multi-vessel diseases, and RBS in ER adjusted OR of 3.83 [95% CI: 1.24-11.79; p=0.019], 1.07 [95% CI: 1.03-1.12; p=0.002], 2.2 [95% CI: 1.07-4.54; p=0.033], and 1 [95% CI: 1.0-1.01; p=0.032], respectively. Conclusion: The controversial phenomenon of smoking paradox seems to be unfolded in South Asian population in post STE-ACS patients. The paradoxical protective role of smoking is confounding effect of mainly younger age, less coronary artery disease burden and complexity, lower prevalence of diabetes and hypertension and lower rate of Killip III/IV at presentation. Hence, the protective effect is insignificant in multivariable analysis and history of CVA/stroke, pre-procedure LVEDP, multi-vessel diseases, and RBS in ER were found to be independent predictors of in-hospital mortality.
目的:本研究的主要目的是揭示南亚人群在临床、血管造影参数及其住院结果方面的争议。方法:在这项研究中，我们纳入了1756例连续诊断为STEMI并接受初级PCI治疗的患者。患者分为吸烟者和非吸烟者。比较两组患者的基线特征、临床表现、血管造影特征和住院死亡率。采用多变量logistic回归分析来评估吸烟的矛盾作用。结果:吸烟者年龄较轻(53.78±11.16岁∶56.43±11.17岁);P <0.001)，男性更常见(98.7%比69.9%;P <0.001)，糖尿病患者较少(19.6% vs. 44.8%;P <0.001)和高血压(38.5% vs. 64.9%;p < 0.001)。Killip III期吸烟者出现的频率较低(5.6%比8.1%;p<0.001)和Killip IV (2.5% vs. 4.8%;P <0.001)。吸烟者多为单血管疾病(41.7% vs. 34.4%;P =0.013)，而非吸烟者有复杂的疾病，经常表现为罪魁祸首血管完全闭塞(64.6% vs. 58.8%;p = 0.040)。并发症如慢流/无流(24.3% vs. 33.2%;P <0.001)和心源性休克(2.3% vs. 4.6%;P <0.001)在吸烟者中也较少见。吸烟者的死亡率明显较低(1.8% vs. 4.3%;p=0.009)与非吸烟者相比，优势比(OR)为0.41 [95% CI: 0.21-0.82, p=0.011]，然而，多变量分析调整后的OR为0.67 [95% CI: 0.31-1.41, p=0.290]。CVA/卒中史、术前LVEDP、多血管疾病和RBS是死亡率的独立预测因素，经ER调整的OR为3.83 [95% CI: 1.24-11.79;p=0.019]， 1.07 [95% CI: 1.03-1.12;p=0.002]， 2.2 [95% CI: 1.07-4.54;p=0.033]， 1 [95% CI: 1.0-1.01;分别p = 0.032)。结论:有争议的吸烟悖论现象似乎在南亚人群的STE-ACS后患者中展开。吸烟的矛盾保护作用主要是年轻、冠状动脉疾病负担和复杂性较低、糖尿病和高血压患病率较低以及发病时Killip III/IV率较低的混淆效应。因此，在多变量分析中，CVA/卒中史、术前LVEDP、多血管疾病和ER中的RBS是院内死亡率的独立预测因子，其保护作用不显著。
{"title":"UNFOLDING THE REALITY OF SMOKING PARADOX IN PATIENTS PRESENTING WITH STE-ACS UNDERGOING PRIMARY PERCUTANEOUS CORONARY TREATMENT","authors":"M. Siddiqui, Rajesh Kumar, J. Sial, M. Karim","doi":"10.47144/phj.v55isupplement1.2418","DOIUrl":"https://doi.org/10.47144/phj.v55isupplement1.2418","url":null,"abstract":"Objectives: Main objective for this study to unfold this controversy in South Asian population in terms of clinical, angiographic parameters and its in-hospital outcomes. \u0000Methodology: In this study, we included 1756 consecutive patients diagnosed with STEMI undergoing primary PCI. Patients were classified into smokers and nonsmokers. Comparison was done on the basis of baseline characteristics, clinical presentation, angiographic features and in-hospital mortality between two groups. Multivariable logistic regression analysis was performed to evaluate the paradoxical role of smoking. \u0000Results: Smokers were younger (53.78±11.16 years vs. 56.43±11.17 years; p<0.001) and more frequently male (98.7% vs. 69.9%; p<0.001), and had less diabetes (19.6% vs. 44.8%; p<0.001) and hypertension (38.5% vs. 64.9%; p<0.001). Smokers presented less frequently in Killip III (5.6% vs. 8.1%; p<0.001) and Killip IV (2.5% vs. 4.8%; p<0.001) in smokers group. Smokers mostly had single vessel disease (41.7% vs. 34.4%; p=0.013) whereas non-smokers had complex disease and frequently presented with total occlusion of the culprit vessel (64.6% vs. 58.8%; p=0.040). Complication such as slow flow/no-flow (24.3% vs. 33.2%; p<0.001) and cardiogenic shock (2.3% vs. 4.6%; p<0.001) were also seen less often among smokers. Smokers has significantly lesser mortality (1.8% vs. 4.3%; p=0.009) compared to non-smokers with an odds ratio (OR) of 0.41 [95% CI: 0.21-0.82, p=0.011], however, adjusted OR on multivariable analysis was 0.67 [95% CI: 0.31-1.41, p=0.290]. Independent predictors of mortality were found to be history of CVA/stroke, pre-procedure LVEDP, multi-vessel diseases, and RBS in ER adjusted OR of 3.83 [95% CI: 1.24-11.79; p=0.019], 1.07 [95% CI: 1.03-1.12; p=0.002], 2.2 [95% CI: 1.07-4.54; p=0.033], and 1 [95% CI: 1.0-1.01; p=0.032], respectively. \u0000Conclusion: The controversial phenomenon of smoking paradox seems to be unfolded in South Asian population in post STE-ACS patients. The paradoxical protective role of smoking is confounding effect of mainly younger age, less coronary artery disease burden and complexity, lower prevalence of diabetes and hypertension and lower rate of Killip III/IV at presentation. Hence, the protective effect is insignificant in multivariable analysis and history of CVA/stroke, pre-procedure LVEDP, multi-vessel diseases, and RBS in ER were found to be independent predictors of in-hospital mortality.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48511655","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 : 2022-11-17DOI: 10.47144/phj.v55isupplement1.2436
A. Ahmad, S. Ashraf, S. Bahadar, Muhammad Irfan, A. Ashraf, M. Hafizullah
Objectives: To compare the coronary artery disease severity in type-2 diabetic and non-diabetic patients suffering from coronary artery disease presenting to cardiology department of Khyber Teaching Hospital, Peshawar. Methodology: This cross sectional study was conducted at Cardiology department of Khyber Teaching Hospital, Peshawar from 29th August 2015 to 17th March 2016. Non probability convenience sampling technique was applied. All patients admitted with acute coronary syndrome or previous known coronary artery disease who were candidate for angiography and revascularization and given consent were included. Patient with type 1 diabetes mellitus, valvular heart diseases, chronic kidney disease, Connective tissue disease, previous percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) were excluded from study. Patient’s coronary angiograms were evaluated for lesions in coronary arteries, number of vessel involved and type of lesions, by two cardiologist with more than five year post fellowship experience first separately and then results were compared for final reporting in order to eliminate bias in reporting. Results: It was noted that male diabetic patients with more were ten years duration of diabetes, smokers with 10 pack years and sedentary life style were more prone to have severe disease in coronary arteries. In diabetic patients severe disease was significantly higher in LAD (55.2% vs. 43%, p <0.01), RCA (63.3% vs. 38 %, p <0.002) and Left Circumflex (62% vs. 35%, p <0.003). Diabetic patients were found to have more extensive disease as compared to non-diabetics, so multi vessel disease was more common in diabetics as compared to non-diabetics (55.7% vs. 21.3 %, p <0.001) . It was noted that Type C lesions were more common in diabetics (33.7% vs. 13.9 %, p <0.001). Diabetic patients were having more severe, diffuse disease multivessel disease in our study population as compared to non-diabetics. Conclusion: Coronary artery disease is more severe, diffuse, aggressive with complicated lesions in diabetic patients having more than 10 years duration of diabetes along with ten pack years history of smoking, with sedentary life style.
目的:比较白沙瓦开伯尔教学医院心内科就诊的2型糖尿病与非糖尿病冠心病患者的冠心病严重程度。方法:本横断面研究于2015年8月29日至2016年3月17日在白沙瓦开伯尔教学医院心内科进行。采用非概率方便抽样技术。所有入院的急性冠状动脉综合征或既往已知的冠状动脉疾病患者，他们都是血管造影和血运重建术的候选人，并得到同意。排除1型糖尿病、瓣膜性心脏病、慢性肾脏疾病、结缔组织疾病、既往经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)患者。患者的冠状动脉造影由两位具有五年以上博士后经验的心脏病专家分别评估冠状动脉病变、受累血管数量和病变类型，然后在最终报告中对结果进行比较，以消除报告中的偏差。结果:糖尿病病程≥10年的男性糖尿病患者、吸烟≥10包年的男性糖尿病患者、久坐生活方式的男性糖尿病患者更容易发生严重的冠状动脉病变。糖尿病重症患者中LAD (55.2% vs. 43%， p <0.01)、RCA (63.3% vs. 38%， p <0.002)和左旋肌(62% vs. 35%， p <0.003)明显增高。与非糖尿病患者相比，糖尿病患者的病变范围更广，因此多血管病变在糖尿病患者中比非糖尿病患者更常见(55.7%比21.3%，p <0.001)。值得注意的是，C型病变在糖尿病患者中更为常见(33.7%比13.9%，p <0.001)。在我们的研究人群中，与非糖尿病患者相比，糖尿病患者有更严重的弥漫性多血管疾病。结论:糖尿病病程≥10年、吸烟史≥10年、久坐生活方式的糖尿病患者冠状动脉病变更为严重、弥漫性、侵袭性且病变复杂。
{"title":"COMPARISON OF CORONARY ARTERY DISEASE SEVERITY AMONG DIABETIC AND NON DIABETIC PATIENTS ADMITTED TO KHYBER TEACHING HOSPITAL, PESHAWAR","authors":"A. Ahmad, S. Ashraf, S. Bahadar, Muhammad Irfan, A. Ashraf, M. Hafizullah","doi":"10.47144/phj.v55isupplement1.2436","DOIUrl":"https://doi.org/10.47144/phj.v55isupplement1.2436","url":null,"abstract":"Objectives: To compare the coronary artery disease severity in type-2 diabetic and non-diabetic patients suffering from coronary artery disease presenting to cardiology department of Khyber Teaching Hospital, Peshawar. \u0000Methodology: This cross sectional study was conducted at Cardiology department of Khyber Teaching Hospital, Peshawar from 29th August 2015 to 17th March 2016. Non probability convenience sampling technique was applied. All patients admitted with acute coronary syndrome or previous known coronary artery disease who were candidate for angiography and revascularization and given consent were included. Patient with type 1 diabetes mellitus, valvular heart diseases, chronic kidney disease, Connective tissue disease, previous percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) were excluded from study. Patient’s coronary angiograms were evaluated for lesions in coronary arteries, number of vessel involved and type of lesions, by two cardiologist with more than five year post fellowship experience first separately and then results were compared for final reporting in order to eliminate bias in reporting. \u0000Results: It was noted that male diabetic patients with more were ten years duration of diabetes, smokers with 10 pack years and sedentary life style were more prone to have severe disease in coronary arteries. In diabetic patients severe disease was significantly higher in LAD (55.2% vs. 43%, p <0.01), RCA (63.3% vs. 38 %, p <0.002) and Left Circumflex (62% vs. 35%, p <0.003). Diabetic patients were found to have more extensive disease as compared to non-diabetics, so multi vessel disease was more common in diabetics as compared to non-diabetics (55.7% vs. 21.3 %, p <0.001) . It was noted that Type C lesions were more common in diabetics (33.7% vs. 13.9 %, p <0.001). Diabetic patients were having more severe, diffuse disease multivessel disease in our study population as compared to non-diabetics. \u0000Conclusion: Coronary artery disease is more severe, diffuse, aggressive with complicated lesions in diabetic patients having more than 10 years duration of diabetes along with ten pack years history of smoking, with sedentary life style.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46060120","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 : 2022-11-17DOI: 10.47144/phj.v55isupplement1.2421
Syed Waqar Ahmed, N. Rahman
Objectives: The aim of this study was to assess the prognostic significance of rSS after PCI for NSTEMI in terms of all-cause mortality and MACE (Major adverse cardiac event) at 3 years of follow-up. Methodology: A retrospective analysis of 115 consecutive NSTEMI patients who underwent PCI at the Aga Khan University Hospital Karachi between January 2016 and December 2016 was performed. 7 patients were excluded from the final analysis due to missing data (n=108). The SYNTAX scores before (baseline syntax=bSS) and after PCI (rSS) were calculated. Patients were stratified as CR if rSS =0, RICR if rSS >0 and ≤8 and ICR if rSS >8. Results: Patients that achieved CR were 44 (40.7%), RICR were 40 (37.7%) and ICR were 24 (22.2%). After three-year follow-up, ICR patients had the highest incidence of both all-cause mortality [(CR) 4.5% vs. (RICR) 5% vs. (ICR) 37.5% respectively; p<0.001] and major adverse cardiovascular (MACE) defined as composite of follow up cardiac death, MI and revascularization [(CR) 5% vs. (RICR) 10% vs. (ICR) 50% respectively; p<0.001]. There was no difference in the incidence of all-cause death (4.5% vs. 5%; p=0.92) or MACE (4.5% vs 10%, p=0.332) in patients with CR and ICR respectively (Table 1). Table 1: Outcomes at two years of follow-up according to residual SYNTAX score MACE- Major Adverse cardiac event (Cardiac death,MI or Revascularisation); CR- complete revascularization; RICR- Reasonable incomplete revascularization; ICR- Incomplete revascularization CR (rSS=0) N= 44 RICR (rSS >0 and ≤8) N= 40 ICR (rSS>8) N= 24 P value CR vs RICR p value CR vs ICR P value RICR vs ICR P value All cause death 2 (4.5) 2 (5) 9 (37.5) <0.001 0.92 <0.001 0.001 Cardiac death 1 (2.3) 2 (5) 7 (29.2) 0.001 0.50 0.001 0.007 MI 1 (2.3) 1 (2.5) 8 (33.3) <0.001 0.949 <0.001 0.001 Revascularization 1 (2.3) 3 (7.5) 3 (12.5) 0.25 0.261 0.087 0.51 MACE 2 (4.5) 4 (10) 12 (50) <0.001 0.332 <0.001 <0.001 Conclusion: The residual SYNTAX score (rSS) is a useful tool in quantifying incomplete revascularization in patients undergoing PCI for NSTEMI. ICR appears to confer a higher three-year mortality and MACE, however outcomes for RICR and CR were comparable. Hence the calculation of rSS in daily practice may also be used to determine a reasonable level of revascularization in patients where complete revascularization may not be possible.
{"title":"A QUANTIFICATION AND IMPACT OF INCOMPLETE REVASCULARIZATION USING RESIDUAL SYNTAX SCORE IN NSTEMI PATIENTS AFTER PERCUTANEOUS CORONARY INTERVENTION","authors":"Syed Waqar Ahmed, N. Rahman","doi":"10.47144/phj.v55isupplement1.2421","DOIUrl":"https://doi.org/10.47144/phj.v55isupplement1.2421","url":null,"abstract":"Objectives: The aim of this study was to assess the prognostic significance of rSS after PCI for NSTEMI in terms of all-cause mortality and MACE (Major adverse cardiac event) at 3 years of follow-up. \u0000Methodology: A retrospective analysis of 115 consecutive NSTEMI patients who underwent PCI at the Aga Khan University Hospital Karachi between January 2016 and December 2016 was performed. 7 patients were excluded from the final analysis due to missing data (n=108). The SYNTAX scores before (baseline syntax=bSS) and after PCI (rSS) were calculated. Patients were stratified as CR if rSS =0, RICR if rSS >0 and ≤8 and ICR if rSS >8. \u0000Results: Patients that achieved CR were 44 (40.7%), RICR were 40 (37.7%) and ICR were 24 (22.2%). After three-year follow-up, ICR patients had the highest incidence of both all-cause mortality [(CR) 4.5% vs. (RICR) 5% vs. (ICR) 37.5% respectively; p<0.001] and major adverse cardiovascular (MACE) defined as composite of follow up cardiac death, MI and revascularization [(CR) 5% vs. (RICR) 10% vs. (ICR) 50% respectively; p<0.001]. There was no difference in the incidence of all-cause death (4.5% vs. 5%; p=0.92) or MACE (4.5% vs 10%, p=0.332) in patients with CR and ICR respectively (Table 1). \u0000Table 1: Outcomes at two years of follow-up according to residual SYNTAX score \u0000MACE- Major Adverse cardiac event (Cardiac death,MI or Revascularisation); CR- complete revascularization; RICR- Reasonable incomplete revascularization; ICR- Incomplete revascularization \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000CR (rSS=0) \u0000N= 44 \u0000 \u0000 \u0000RICR (rSS >0 and ≤8) \u0000N= 40 \u0000 \u0000 \u0000ICR (rSS>8) \u0000N= 24 \u0000 \u0000 \u0000P value \u0000 \u0000 \u0000CR vs RICR \u0000p value \u0000 \u0000 \u0000CR vs ICR \u0000P value \u0000 \u0000 \u0000RICR vs ICR \u0000P value \u0000 \u0000 \u0000 \u0000 \u0000All cause death \u0000 \u0000 \u00002 (4.5) \u0000 \u0000 \u00002 (5) \u0000 \u0000 \u00009 (37.5) \u0000 \u0000 \u0000<0.001 \u0000 \u0000 \u00000.92 \u0000 \u0000 \u0000<0.001 \u0000 \u0000 \u00000.001 \u0000 \u0000 \u0000 \u0000 \u0000Cardiac death \u0000 \u0000 \u00001 (2.3) \u0000 \u0000 \u00002 (5) \u0000 \u0000 \u00007 (29.2) \u0000 \u0000 \u00000.001 \u0000 \u0000 \u00000.50 \u0000 \u0000 \u00000.001 \u0000 \u0000 \u00000.007 \u0000 \u0000 \u0000 \u0000 \u0000MI \u0000 \u0000 \u00001 (2.3) \u0000 \u0000 \u00001 (2.5) \u0000 \u0000 \u00008 (33.3) \u0000 \u0000 \u0000<0.001 \u0000 \u0000 \u00000.949 \u0000 \u0000 \u0000<0.001 \u0000 \u0000 \u00000.001 \u0000 \u0000 \u0000 \u0000 \u0000Revascularization \u0000 \u0000 \u00001 (2.3) \u0000 \u0000 \u00003 (7.5) \u0000 \u0000 \u00003 (12.5) \u0000 \u0000 \u00000.25 \u0000 \u0000 \u00000.261 \u0000 \u0000 \u00000.087 \u0000 \u0000 \u00000.51 \u0000 \u0000 \u0000 \u0000 \u0000MACE \u0000 \u0000 \u00002 (4.5) \u0000 \u0000 \u00004 (10) \u0000 \u0000 \u000012 (50) \u0000 \u0000 \u0000<0.001 \u0000 \u0000 \u00000.332 \u0000 \u0000 \u0000<0.001 \u0000 \u0000 \u0000<0.001 \u0000 \u0000 \u0000 \u0000 \u0000Conclusion: The residual SYNTAX score (rSS) is a useful tool in quantifying incomplete revascularization in patients undergoing PCI for NSTEMI. ICR appears to confer a higher three-year mortality and MACE, however outcomes for RICR and CR were comparable. Hence the calculation of rSS in daily practice may also be used to determine a reasonable level of revascularization in patients where complete revascularization may not be possible.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41335813","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 : 2022-11-17DOI: 10.47144/phj.v55isupplement1.2435
Muhammad Ishaq Khan, Rafiullah Jan, Muhammad Waleed, Wali Saleem
Objectives: Primary percutaneous coronary intervention (PPCI) is the standard of care for ST-elevation myocardial infarction (STEMI) worldwide. Recommended by the latest guidelines (1). In Pakistan only a handful centres offer PPCI services, many others rely on thrombolysis as the reperfusion strategy for STEMI patients which has been shown to be inferior to primary PCI (2). In our province the PPCI facility is even harder to offer where infrastructure and economic conditions of the public is lagging behind many areas in the country. Ours is a study from a public sector hospital in its infancy. We present our data of a single centre and believe that it will help shape the policy of the government in favour of expanding PPCI facilities. To share the primary PCI data of our centre. Methodology: It was a retrospective observational study. All comers who underwent PPCI for STEMI in Peshawar Institute of Cardiology from March 2022 to August 2022were enrolled. All procedures were performed by experienced interventional cardiologists or their fellows under their direct supervision. Results: A total of 337 patients were enrolled in the study. The mean age was 53 ± 16 years. 73 % (n = 246) were males. Most commonly involved culprit artery was LAD (47%) followed by RCA (34%). 16.9% (n = 57) patients had triple vessel disease, 35 % (n = 119) double vessel disease and 47.7% (n = 161) had only one vessel disease. LMS disease was diagnosed in 18 (5.3%) patients, out of which 4 (1.1%) were stented during the index procedure. In-hospital mortality was 3% (n = 10), out of which 6 (1.8 %) patients were in cardiogenic shock and all were on inotropic support. Four patients (1.1%) needed intubation and balloon pump was used in another 4 (1.1 %) patients. Second and third generation DES were used in 86% (n = 290), POBA in 08% (n = 27), urgent surgical referral was done in 03 % (n = 10) while in 03% (n = 10) patients no stenting was done. Intravascular ultrasound was used in 4 (1.1%) cases. Conclusion: Primary PCI can be offered in public sector hospital to our population. The need of the hour is to delegate more resources to this life saving procedure.
{"title":"PPCI OUTCOMES","authors":"Muhammad Ishaq Khan, Rafiullah Jan, Muhammad Waleed, Wali Saleem","doi":"10.47144/phj.v55isupplement1.2435","DOIUrl":"https://doi.org/10.47144/phj.v55isupplement1.2435","url":null,"abstract":"Objectives: Primary percutaneous coronary intervention (PPCI) is the standard of care for ST-elevation myocardial infarction (STEMI) worldwide. Recommended by the latest guidelines (1). In Pakistan only a handful centres offer PPCI services, many others rely on thrombolysis as the reperfusion strategy for STEMI patients which has been shown to be inferior to primary PCI (2). In our province the PPCI facility is even harder to offer where infrastructure and economic conditions of the public is lagging behind many areas in the country. Ours is a study from a public sector hospital in its infancy. We present our data of a single centre and believe that it will help shape the policy of the government in favour of expanding PPCI facilities. To share the primary PCI data of our centre. \u0000Methodology: It was a retrospective observational study. All comers who underwent PPCI for STEMI in Peshawar Institute of Cardiology from March 2022 to August 2022were enrolled. All procedures were performed by experienced interventional cardiologists or their fellows under their direct supervision. \u0000Results: A total of 337 patients were enrolled in the study. The mean age was 53 ± 16 years. 73 % (n = 246) were males. Most commonly involved culprit artery was LAD (47%) followed by RCA (34%). 16.9% (n = 57) patients had triple vessel disease, 35 % (n = 119) double vessel disease and 47.7% (n = 161) had only one vessel disease. LMS disease was diagnosed in 18 (5.3%) patients, out of which 4 (1.1%) were stented during the index procedure. In-hospital mortality was 3% (n = 10), out of which 6 (1.8 %) patients were in cardiogenic shock and all were on inotropic support. Four patients (1.1%) needed intubation and balloon pump was used in another 4 (1.1 %) patients. Second and third generation DES were used in 86% (n = 290), POBA in 08% (n = 27), urgent surgical referral was done in 03 % (n = 10) while in 03% (n = 10) patients no stenting was done. Intravascular ultrasound was used in 4 (1.1%) cases. \u0000Conclusion: Primary PCI can be offered in public sector hospital to our population. The need of the hour is to delegate more resources to this life saving procedure.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42596241","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 : 2022-11-17DOI: 10.47144/phj.v55isupplement1.2424
K. Khan
Objectives: The compression duration of the radial artery remained a key concern after coronary angiography (CA) and interventions via trans-radial access (TRA). We evaluate the impact of application of steri-strips along with conventional pneumatic trans-radial (TR) band on duration of compression required for hemostasis after diagnostic CA. Methodology: In this open labeled randomized clinical trial, total of 209 patients who underwent diagnostic CA were randomized in 1:1 ratio into TR band with steri-strips (treatment) and conventional TR band alone (control) for achieving hemostasis. All patients were followed for 1 month. The primary endpoint was the duration of application of TR band and secondary endpoints were radial artery occlusion (RAO) and major bleeding. Results: 106 patients received steri-strip along with TR band and 103 patients received TR band alone. The median duration of application of TR band was 60 [IQR: 60-60] min in the treatment group and 250 [IQR: 240-360] min in the control group; p≤0.001. The major bleed requiring reapplication of TR band was 9.4% vs. 4.9%; p=0.364 and hematoma (type I only) was 7.5% vs. 9.7%, p=0.578 in the treatment and control group respectively. Radial artery was palpable in 95.3% vs. 85.4%; p=0.016 after 24 hours and 96.2% vs. 88.3%; p=0.0.032, at 1 month in the treatment and control arm respectively. Conclusion: Use of steri-strips is helpful in significantly reducing the compression duration of TR band and improving the patency of radial artery after diagnostic angiography with no significant rise in hematoma or major bleeding complications. Keywords: Steri-strips, radial artery, pneumatic TR band, coronary angiography, radial artery patency, radial artery occlusion.
{"title":"USE OF THE STERI-STRIPS IN ACHIEVING RADIAL ARTERIAL ACCESS HEMOSTASIS","authors":"K. Khan","doi":"10.47144/phj.v55isupplement1.2424","DOIUrl":"https://doi.org/10.47144/phj.v55isupplement1.2424","url":null,"abstract":"Objectives: The compression duration of the radial artery remained a key concern after coronary angiography (CA) and interventions via trans-radial access (TRA). We evaluate the impact of application of steri-strips along with conventional pneumatic trans-radial (TR) band on duration of compression required for hemostasis after diagnostic CA. \u0000Methodology: In this open labeled randomized clinical trial, total of 209 patients who underwent diagnostic CA were randomized in 1:1 ratio into TR band with steri-strips (treatment) and conventional TR band alone (control) for achieving hemostasis. All patients were followed for 1 month. The primary endpoint was the duration of application of TR band and secondary endpoints were radial artery occlusion (RAO) and major bleeding. \u0000Results: 106 patients received steri-strip along with TR band and 103 patients received TR band alone. The median duration of application of TR band was 60 [IQR: 60-60] min in the treatment group and 250 [IQR: 240-360] min in the control group; p≤0.001. The major bleed requiring reapplication of TR band was 9.4% vs. 4.9%; p=0.364 and hematoma (type I only) was 7.5% vs. 9.7%, p=0.578 in the treatment and control group respectively. Radial artery was palpable in 95.3% vs. 85.4%; p=0.016 after 24 hours and 96.2% vs. 88.3%; p=0.0.032, at 1 month in the treatment and control arm respectively. \u0000Conclusion: Use of steri-strips is helpful in significantly reducing the compression duration of TR band and improving the patency of radial artery after diagnostic angiography with no significant rise in hematoma or major bleeding complications. Keywords: Steri-strips, radial artery, pneumatic TR band, coronary angiography, radial artery patency, radial artery occlusion.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49550699","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：