Angiographic Profile Research Articles

Post Thrombolytic Angiographic Profile and TIMI Flow in Patients with ST-Elevation Myocardial Infarction

Background: Myocardial infarction (MI) is the leading cause of morbidity and mortality worldwide. Primary Percutaneous coronary intervention (PPCI) is recommended as a treatment of choice in patients with STEMI but fibrinolysis also remains prevalent as a reperfusion strategy in most of the patients with STEMI presenting to non-PCI capable hospitals where timely PPCI cannot be performed. Objectives: To assess the angiographic characteristics and angiographic success of thrombolysis in terms of TIMI 3 flow in patients who underwent angiography after thrombolysis for STEMI and the factors most commonly associated with unsuccessful thrombolysis. Methods: All 130 hospitalized patients in the department of Cardiology, at Bolan Medical Complex Hospital, Quetta from 31st July 2021 to 30th November 2021 with an acute ST-segment elevation MI (STEMI) diagnosis who received thrombolytics were included in this observational study. We didn't include patients who couldn't benefit from thrombolysis e.g. NSTEMI, contraindication to thrombolytics, and refused fibrinolysis. A 12-lead electrocardiogram (ECG) was performed when the patient arrived in ER and a repeat ECG was done 90 minutes after the administration of a thrombolytic agent (streptokinase). To assess the angiographic success of thrombolysis, coronary anatomy, and TIMI flow, we performed coronary angiography in all patients included in this study. Results: The study included 130 patients, 72 of whom had successful thrombolysis and 58 who had unsuccessful thrombolysis. Angiography reported TIMI 3 flow rates of 48(36.9%). Subjects in the unsuccessful thrombolysis group had the single-vessel disease in 29 (50%) and a multi-vessel disease was found in 19 (32.75%) of the patients. Patients with successful thrombolysis had Single vessel disease 6 (19.3%), Multivessel disease 1 (3.2) It was observed that patients with diabetes mellitus had a significant rise in the number of failed thrombolysis compared to those without diabetes mellitus (p<0.005). It was also observed that anterior wall MI was significantly at risk for a failure in thrombolysis (82.1%) compared to inferior wall MI (17.8%). Conclusions: Effective thrombolysis was more prevalent than failed thrombolysis in our study. This data reiterates the utility of thrombolysis in resource-limited settings. Patients with diabetes, anterior wall MI, and delay in the presentations of the patients have a higher risk of thrombolysis failure. Type B lesions and multivessel disease were also prevalent in subjects with unsuccessful thrombolysis. According to the findings of this study, screening for risk factors before starting thrombolysis can aid in the development of alternative treatment methods that reduce failure rates and redirect resources to more successful treatment options. Keywords: Post thrombolytic; Angiographic Profile, TIMI flow; St-elevation; Myocardial Infarction

Association of Diabetes Mellitus and Hypertension with Angiographic Profile of Acute Coronary Syndrome Patients

Background: Cardiovascular diseases are the leading cause of death worldwide while ischemic heart disease is a major contributor of cardiovascular diseases and diabetes mellitus is one of the major risk factor for ischemic heart diseases. Cardiac involvement in diabetes commonly manifest as coronary artery disease (CAD) of different extent which has an impact on disease outcome and prognosis. Aim: To compare the angiographic profiles between diabetic and non-diabetic patients with acute coronary syndrome (ACS). Place and duration of study: National Institute of Cardiovascular Diseases, Karachi, Pakistan from 1st Feb. 2020 to 31st Jan. 2021. Methodology: Two hundred and ninety eighty patients with acute coronary syndrome were enrolled. Demographic profile, personal and family history was taken through questioner. Angiography was performed to assess the angiographic profile in terms of extent of the disease, left main disease (LMD) involvement, severity of disease, and localization of disease to see the association with variables. Results: The mean age was 56.38±8.90 years and 240 (81%) were males and 58 (19%) were females. The diabetic patients have higher frequency of three vessels involved, localization of left anterior descending (LAD) and right coronary artery (RCA) with significant difference (p<0.0001 respectively). Left main disease was noted in 21 (25.3%) of diabetic participants and severe disease was found among 119 (56.4%) of diabetic participants with significant difference compared to non-diabetics (p<0.001). Angiographic profile was also found to be significantly different among hypertensive and non-hypertensive participants (p<0.05) Conclusion: There is higher frequency of diabetes in patients with ACS and most of them are male. While severity of disease, involvement of RCA and LAD in patients with acute coronary syndrome is quite high in patients with diabetes mellitus as compared to non-diabetic patients. Hypertension was also found to be associated with angiographic profile. Keywords: Coronary artery disease, Coronary angiography, Diabetic, Non-diabetic, Acute coronary syndrome

Association of RNF213 Variants With Periventricular Anastomosis in Moyamoya Disease.

The pathogenic mechanisms of periventricular anastomosis (PA) in moyamoya disease remain unknown. Here, we aimed to describe the angiographic profiles of PA and their relationships with really interesting new gene (RING) finger protein 213 (RNF213) genotypes. We conducted a retrospective cohort study of moyamoya disease patients consecutively recruited between June 2019 and January 2021 in Beijing Tiantan Hospital, Capital Medical University, China. C-terminal region of RNF213 was sequenced. Angiographic characteristics of PA vessels (lenticulostriate artery, thalamotuberal artery, thalamoperforating artery, anterior choroidal artery, and posterior choroidal artery) were compared between different groups of RNF213 genotypes. The dilatation and extension of PA vessels were measured by using PA score (positive, score 1-5; negative, score 0). Multivariate regression analysis was conducted to assess variables associated with PA score. In addition, gene expression of RNF213 in human brain regions was evaluated from the Allen Human Brain Atlas. Among 260 patients (484 hemispheres), 71.2% carried no RNF213 rare and novel variants, 20.0% carried p.R4810K heterozygotes, and 8.8% carried other rare and novel variants. PA scores in patients with p.R4810K and other rare and novel variants were significantly higher than in wild-type patients (P<0.001). Age (odds ratio [OR], 0.958 [95% CI, 0.942-0.974]; P<0.001), platelet count (OR, 0.996 [95% CI, 0.992-0.999]; P=0.027), p.R4810K variant (OR, 2.653 [95% CI, 1.514-4.649]; P=0.001), other rare and novel variants (OR, 3.197 [95% CI, 1.012-10.094]; P=0.048), Suzuki stage ≥4 (OR, 1.941 [95% CI, 1.138-3.309]; P=0.015), and posterior cerebral artery involvement (OR, 1.827 [95% CI, 1.020-3.271]; P=0.043) were significantly correlated with PA score. High expression of RNF213 was detected in the periventricular area. RNF213 variants were confirmed to be associated with PA in moyamoya disease. Individuals with RNF213 p.R4810K heterozygotes and other C-terminal region rare variants exhibited different angiographic phenotypes, compared with wild-type patients.

Acute myocardial injury and infarction in patients under 45 years old - a single centre experience

Abstract Funding Acknowledgements Type of funding sources: None. Acute myocardial injury and infarction is vastly described in patients over 45 years of age. However, the higher incidence of coronary artery disease (CAD) in young patients in recent decades has led to a concomitant increase in the importance of excluding coronary artery disease in this group. The aim of this study was to analyse the prognosis in young patients with acute myocardial injury and infarction. Additionally, we intend to evaluate the clinical features and angiographic profile. We retrospectively analysed all patients under 45 years of age with acute chest pain and elevated troponin who underwent coronary angiography in our department from January 2017 to April 2021. Patient selection and information collection were obtained through medical records. The patients were categorized into three groups, based on discharge diagnosis: group 1 for ST-segment elevation myocardial infarction (STEMI) patients, group 2 for non-ST-segment elevation myocardial infarction (NSTEMI) patients and group 3 for patients with angiographically normal coronary arteries. Outcomes were left ventricular dysfunction, assessed by left ventricular ejection fraction (LVEF) in transthoracic echocardiography; the occurrence of electrical complication during hospitalization, including sustained ventricular tachycardia, ventricular fibrillation or cardiorespiratory arrest; and in-hospital mortality. Group comparisons were performed. A p-value less than 0.05 was considered significant. Statistical analysis was performed using SPSS software v.25.0. One hundred twenty-one patients were analysed: 59 (48.8%) in group 1, 28 (23.1%) in group 2 and 34 (28.1%) in group 3. Table 1 describes the main baseline characteristics. There was a significant difference between the groups for smoking (p-value = 0.03), more prevalent in group 1 and less prevalent in group 3. Regarding outcomes, there was a significant difference for left ventricular dysfunction at discharge, with a mean LVEF of 50% in group 1, 53% in group 2, and 58% in group 3 (p-value &amp;lt; 0.01). The existence of electrical complications was similar for the three groups (p-value = 0.99), and all patients were discharged alive. In conclusion, young patients with acute myocardial injury and infarction have a similar clinical history, with the exception of smoking in STEMI patients. There was a higher prevalence of left ventricular dysfunction in patients with STEMI, similar to that observed in older patients. A multicentric analysis, as well as a long-term follow-up, would be interesting to confirm these results.

IMPACT OF SMOKELESS TOBACCO USE ON DISTRIBUTION OF VESSEL INVOLVEMENT IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objectives: Despite widespread use of smokeless tobacco (ST) in Pakistan, a very limited empirical evidence have been reported regarding its impact on the coronary anatomy and obstructions. Therefore, this study was conducted to compare the coronary angiographic profile of smokeless tobacco (ST) users and smokers with non-tobacco users presented with acute myocardial infarction (AMI). Methodology: Consecutive patients with AMI were stratified in to four groups as tobacco non-users (G1), solo ST users (G2), both smoking and ST users (G3), and solo smokers (G4). Coronary angiographic findings regarding number of diseases vessels and infarct related artery were recorded. Results: Out of 326 patients, ST users were 28.2%(92), 6.4%(21) in conjunction with smoking and reaming 21.8%(71) without smoking. Females were 19.7%(14/71) of G2, 4.8%(1/21) of G3, 0% in G4. Young patients (≤ 40 years) were 3.4%(5/149) of G1, 9.9%(7/71) of G2, 14.1%(12/85) of G4, and 23.8%(5/21) of G3 cumulatively making 82.8%(24/29) of the young patients. Single vessel disease (SVD) and left anterior descending artery (LAD) were significantly higher among ST user as compared to non-users with distribution of 46.7% vs. 34.2% and 70.7% vs. 56.4% respectively. Conclusion: The distribution and localization of involved vessels among ST users with AMI are same as that of smokers with SCD and LAD as infarct artery as the common findings. Tendency of ST use is also high among female patients and Tobacco use in either form, smoking or smokeless, is alarmingly high (&gt;80%) among young (≤40 years) patients with AMI.

Role of C - Reactive Protein as an Inflammatory Marker in Patients with Coronary Artery Disease: A Case – Control Study in Erbil- Kurdistan Region of Iraq

Background and aim: Inflammation has been long regarded as a key contributor to atherosclerosis. Recent decades have provided extensive and mounting evidence concerning the pivotal interplay between inflammation and CAD, reinforcing the concept of inflammation not only as a risk marker but also as a risk factor for the development and progression of atherosclerotic disease. Methods: This was a case control study that has been enrolled among 404 patients, divided into two different groups (case-CAD patients and control group-Patients with Normal Coronary Angiography) that presented to Catheterization unit of Surgical Specialty Hospital- Cardiac Center/ Erbil City-Iraq from 1 Sept 2021 to 1 Jan 2022. Results: A total of 404 patients of case and control group was included from both genders, the mean age was 55.9 ±10.6, ranging from 30 to 77 years of age, based on their coronary angiographic profile 57.4% of them were Coronary Artery Disease cases and 42.6% were controls. (58.4%) of the study population were males and (41.6%) were females. The mean of CRP level amongst cases were higher (6.2 ± 10) than the controls (3.5 ± 4.7), and this was significant with a P = 0.022. In our study we found that Highly Sensitive-CRP was high amongst Case Group (Patients with CAD) by 70% while comparing to only 30% of Control group who had High CRP levels. And this was statistically significant with a P value of 0.003. Conclusion: The level of CRP was higher among patients with Coronary Artery Disease, than those with Normal Coronary Angiography. The level was higher among.

Angiographic Profiles in Persistent Non-Valvular Atrial Fibrillation Patients

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Cardiology dept. PGIMER, Chandigarh Background The relationship of atrial fibrillation (AF) with coronary artery disease (CAD) is well established. Atrial ischemia due to obstructive CAD has been identified as one of the key risk factors, leading to AF. However, sufficient evidence exists as to the presence of myocardial ischemia on stress imaging, even without the presence of obstructive CAD in AF patients. Slow flow and coronary tortuosity on angiogram can lead to downstream myocardial ischemia independent of CAD. Purpose We aimed to delineate the angiographic profiles in AF patients with attention to slow flow and tortuosity leading to ischemia in those without obstructive CAD. Methods The study was a nonrandomised, prospective, single-centre observational study of consecutive patients of persistent non valvular AF. Symptomatic patients despite optimal medical therapy (OMT) for 3 months were recruited and all underwent coronary angiograms (CAG). Patients with known CAD or prior history of myocardial infarction were excluded. Further angiographic analysis was done in those without obstructive CAD to determine incidence of slow flow (&amp;gt;27 corrected TIMI frame count) and tortuosity (presence of ≥3 fixed bends in an epicardial artery). Results A total of 70 patients were recruited and followed for a mean duration of 12 ± 1.4 months. The mean age of the study group was 66.07 (±11.49). Hypertension (74%) was the commonest comorbidity followed by obesity (35%) and diabetes (30%). At CAG, 32/70 (46%) had obstructive CAD, 17/70 (24%) had non obstructive (&amp;lt;50-70% stenosis) CAD and 21/70 (30%) had normal coronaries without atherosclerosis. Amongst patients without obstructive CAD (n = 38) slow flow was seen in 16/38 (42%) and coronary tortuosity in 11/38 (29%) patients. There ware no differences in terms of death, HF and FVR hospitalisations or stroke at follow up between the obstructive CAD vs no obstructive CAD. However in patients without obstructive CAD, hospitalisations for FVR was significantly increased in those having slow flow on CAG, 9/12 (75%) vs 7/26 (27%) in those without slow flow (p value = 0.005). The mean TIMI frame count was also significantly higher in those with FVR hospitalisations 35.3 ± 11 vs 25.8 ± 8.9 (p value = 0.005). TIMI frame count &amp;gt;31 had a sensitivity of 83% and a specificity of 69% for predicting hospitalisations for FVR on ROC curve(AUC = 0.71). Conclusions CAD is closely related to AF and majority (70%) of our patients had evidence of atherosclerotic CAD on CAG in our study. A large proportion of patients with no evidence of obstructive CAD on CAG had slow flow or coronary tortuosity. Significantly increased hospitalisation for FVR seen in the slow flow group shows its significance and may lead to newer treatment modalities in future. Further larger studies looking at these aspects on CAG may give further insight as to the nature and prognosis of these entities. Abstract Figure 1: Flow diagram showing the patie

CRT-100.15 Angiographic Profile and Laboratory Predictors of Coronary Slow Flow Phenomenon in South Indian Population

CRT-100.15 Angiographic Profile and Laboratory Predictors of Coronary Slow Flow Phenomenon in South Indian Population

Comparison of Clinical and Angiographic Profiles of Patients with or without Left Main Coronary Artery Disease

Background: Left main coronary artery disease constitutes highest risk lesion subset of CAD population. Flow dynamics and pathophysiology in the left main coronary artery are different from that of the other coronary arteries. So traditional risk factors might interact differently with left main artery resulting in different clinical and angiographic characteristics compared to others. Anatomic pattern evaluation in left main coronary artery disease is important in deciding best management options. However, their pattern and profiles were variably shown in different studies with discrepant Results suggesting geographic variation and lead to evaluation of characteristics in our own population. Better understanding this specific problem might lead to further improvement in its management. Methods: It was an observational cross-sectional study. Ninety-one adult coronary artery disease patients over the period of one year who underwent invasive coronary angiogram were studied. Study subjects were divided into two groups after coronary angiogram: Left main (Group 1) and Non-left main (Group 2) CAD. Demographic data, risk factor profiles and angiographic patterns of both groups were compared to see if any statistically significant difference present or not. Results: The mean age and standard deviation in group 1 is 55.2±9.4 and in group 2 is 55.5±12.9; the comparative analysis showed no statistically significant difference. Most of the patients were male 69 (76%) and the comparative study showed statistically significant differences (p=0.046) which showed left main disease tended to be higher in male. Majority (64%) had BMI in normal range with no significant difference. Among the risk factors comparison, diabetes and family history of CAD showed significant association with the left main cohort (p&lt;0.05). Non-ST elevated ACS was the most common presentation and significantly associated with the left main group (p&lt;0.05). On coronary angiogram, there were 80 patients (87.92%) who had no left main artery involvement while 11 patients (12.08%) had left main disease. The comparative study of coronary artery involvement among the two groups reveals no statistically significant differences (p&gt;0.05) but triple vessel disease was found more commonly than single and double vessel disease. Distal lesions (64%) were found more frequently than other types of left main stenosis followed by ostio-proximal lesion (36%). Conclusion: In the patients with left main coronary artery disease, male gender, diabetes mellitus, positive family history and presentation with non-ST elevation ACS were found to be significantly associated. Distal left main lesion and triple vessel disease were commonly found. University Heart Journal 2022; 18(1): 3-9

CLINICAL AND ANGIOGRAPHIC PROFILE OF CORONARY ARTERY DISEASE IN YOUNG WOMEN - A TERTIARY CARE CENTRE STUDY FROM NORTH EASTERN INDIA

Background: Coronary artery disease (CAD) is the biggest killerof women globally.CAD among young women as a group is less easily recognized worldwide. Young women are underrepresented in most of theCAD studies. This study assessed Clinical and angiographic profile of CAD in young women of North-East India to have a better understanding of the nature and courseof the disease. Material and Methods:This was a prospective, observational, single centre analytical study. Totalparticipants were divided into 2 groups – young women less than 55 years and old women more than or equal to 55 years.Modes ofpresentation,riskfactors,clinicalandangiographicprofileofCADwere compared. Risk factors studied were smoking, hypertension, diabetes mellitus,dyslipidaemia, obesity and family history of prematureCAD.CADseveritywas assessedby SyntaxscoreandGensiniscore. Results: A total of 143women were studied. Out of these 57 women were &lt;55 years and 86 women were ≥ 55years of age. Hypertensionwasthe mostcommonriskfactor foundin both groups of women followed by diabetes and dyslipidaemia. Most common presentation among youngerwomen were chronic stable anginafollowed by ST elevation myocardial infarction (STEMI). In younger women most of them had normal Left Ventricular Ejection Fraction, 54.4 % vs 41.9% of patients(p=0.04).Younger women had normal coronaries in19.3% vs. 9.3% in older women (p=0.072).Younger women had significantly lower number of multivessel diseases than older women, 29.8% vs 44.18% (p = 0.045). Left Anterior Descending coronary artery (LAD) was the most common coronary artery involved in both groups (43.9% vs 52.3%). Low Syntax score (≤22) and lowGensini score (≤20) were found in younger women 75.4% vs older women 67.4% (p=0.201)and 56.1% vs. 40.7% (p=0.05), respectively. The increase in Syntax and Gensini score with increase in number of risk factors were found to be statistically significant in both the groups. Conclusion: In younger women, most of the patients presented withchronic stable angina and STEMI with a preceding history of angina. Hypertension and diabetes were most common risk factors both being modifiable needsutmost attention for prevention. Coronary angiography revealedless severe CAD in younger women than older women as assessed by coronary severity score.

In-Hospital Outcome and Angiographic Profile of Elderly Patients with Non-ST Segment Elevation Myocardial Infraction

Background: Non-ST Segment elevation myocardial infarction is heterogeneous in its presentation. Like ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction is life-threatening of a major cause of emergency medical care and hospitalization. Patients with non-ST segment elevation myocardial infarction are at risk for adverse cardiac events, so the initial treatment is very important. Increasing age is a strong predictor of adverse events in non-ST segment elevation myocardial infarction patients. Objective: To determine the in-hospital outcome and severity of coronary artery disease of older patients with Non-ST Segment elevation myocardial infarction. Methods: This was a descriptive cross-sectional study. The study was carried out in the cardiology department, National Heart Foundation Hospital, and Research Institute from June 2011 to May 2012. Patients of Non-ST Segment elevation myocardial infarction admitted at National Heart Foundation &amp; Research Institute who fulfill the inclusion criteria were the study population. Patients were recruited by nonrandom sampling. One hundred and thirty-four patients were recruited in this study. Data were prospectively collected in a pre-designed data collection form and analyzed using SPSS - 16 software. Results: In this study, patients had a greater prevalence of hypertension diabetes mellitus. Chest pain and shortness of breath were common presentations observed in study patients during admission. They had a lower left ventricular ejection fraction than their younger counterparts. The older group was associated with an increased risk of triple vessel disease. In-hospital complications were significantly higher in older patients. Duration of hospital stay was longer in older patients. Conclusion: Older patients with Non-ST Segment myocardial infarction strongly predict adverse in-hospital outcomes and severe coronary artery disease profiles. Older patients should alert physicians to an increased risk of morbidity and mortality, which may, in turn, support more judicious treatment, including appropriate utilization of cardiovascular diagnostic tests and therapeutics used in current cardiovascular care to optimize outcomes in these high- risk patients.

Prevalence of metabolic syndrome and its clinical and angiographic profile in patients with naive acute coronary syndrome

Objective: The objective of the study is to evaluate the prevalence of metabolic syndrome (MS) and its clinical and angiographic profile in patients with naive acute coronary syndrome (ACS). Furthermore, this study tried to evaluate the severity of coronary artery disease in patients with and without MS. Methods: This was a single-center, cross-sectional study which prospectively enrolled 500 patients with naive ACS during the period from January 2017 to December 2018 at a tertiary care center in India. They were divided into two groups according to the presence and absence of MS based on revised NCEP ATP III guidelines. The ACS was defined based on the Joint Committee of the American College of Cardiology. After clinical evaluation and investigations, the prevalence of MS in ACS patients was calculated. Results: Prevalence of MS in this study was 46.2% and was more frequent in males (81%) compared to females (19%). Maximum number of patients with MS were between the age group of 40–59 years (55%). Prevalence of diabetes (56.7%), hypertension (58.0%), and smoking (45.88%) were significantly higher in patients with MS (P < 0.001). Most prevalent components of MS were low high-density lipoprotein (HDL) levels, increased blood pressure, fasting blood sugar, and triglyceride levels (P < 0.001). Conclusion: Prevalence of MS was high in patients with ACS and was more often after the age of 40 years and most commonly seen in males. Low HDL levels, increased blood pressure, and blood sugar were most prevalent components in the criteria for MS. Patients with MS tend to have more complex coronary lesions.

Assessment of risk factors, clinical presentation and angiographic profile of coronary slow flow phenomenon

Background: Primary coronary slow flow phenomenon (PCSFP) is a clinical entity that causes attacks of mild to severe chest pain. It is characterized by delayed coronary vessel opacification in the absence of epicardial stenosis. This work aimed for the assessment of predictors, clinical presentation, and angiographic profile of PCSFP. Subjects and Methods: This cross-sectional case–control study was done between February 2019 and January 2020, including 150 patients who presented by ST-segment myocardial infarction, non-ST segment myocardial infarction, unstable angina, chronic coronary syndrome, or atypical chest pain. The patients were divided into two groups: group 1: consisted of 100 patients who had PCSFP and Group 2: consisted of 50 patients who had normal coronary flow (NCF). Results: PCSFP was significantly more prevalent in young male patients. Among the traditional risk factors, there was significantly more prevalence of hypertension (63.0% vs. 28.0%, P = 0.001), obesity (body mass index ≥30 kg/m2 (47.0% vs. 4.0%, P = 0.001), and history of smoking (66.0% vs. 40.0%, P < 0.002) in PCSFP patients as compared to NCF patients. Triglyceride (TG), cholesterol, low-density lipoprotein, high-sensitivity C-reactive protein (hs-CRP), and hemoglobin all were higher in patients with PCSFP. Low high-density lipoprotein levels were associated with PCSFP. In multivariable analysis, PCSFP was significantly independently associated with male sex, high TG, cholesterol, and hs-CRP. TG (odds ratio [OR]: 14.427, 95% confidence interval [CI]: 3.514–59.226) and cholesterol (OR: 11.739, 95% CI, 2.439–56.513) are the strongest independent predictors for PCSFP. Conclusion: PCSFP is more common in young smoker males, is associated with hypertension, obesity, high hs-CRP, TG, and cholesterol levels. High cholesterol and TG and male sex are the strongest risk factors for PCSFP. Furthermore, inflammation plays an important factor in the pathogenesis of PCSFP due to the association of high hs-CRP level in those patients.

Sex Differences in Clinical and Angiographic Characteristics in Acute Coronary Syndrome Patients in Dakar, Senegal

Background: Coronary artery disease (CAD) is in relentless progression, along with the adoption of western lifestyle in sub-Saharan Africa. In Senegal, the incidence of acute coronary syndrome (ACS) rose from 5% to 12% in Dakar during the last 20 years. That increase was observed in both women and men, and according to current data, the former paid the heaviest price in terms of mortality compared to men. In this study, we aim to retrospectively assess the clinical characteristics and angiographic profile of ACS in women compared to men in two tertiary care centers in Dakar. Methods: In this study, we retrospectively analyzed and compared data between men and women among 133 patients who underwent coronary angiogram for ACS in 2 tertiary centers from February 2019 to January 2020. Results: A total of 133 patients were included in our study of whom 97 (72.9%) were men. The mean age was 58 ± 13.6 years. Women were older than men (61.4 ± 14.3 years vs 56.6 ± 13.5 years (p = 0.07). Hypertension, sedentary lifestyle and obesity were significantly more frequent in women (69.4%, 52.7% and 19.4%) when compared to men (38.8%, 25.7% and 6.19%) respectively, (p = 0.001; 0.002 and 0.03). Smoking was less frequent in women (2.8%) than in men (44.3%), (p Conclusion: In our study, women with ACS were older, had more cardiovascular risk factors but less angiographic extent of disease than men.

Clinical and Angiographic Profile of Acute Coronary Syndrome among Young Adults

Subaortic stenosis remains difficult to manage due to the unpredictable progression of the stenosis and the high rate of recurrence after surgical treatment. The aims of our study were to describe the clinical and paraclinical profile of patients operated on for subaortic stenosis and to analyze the factors associated with postoperative recurrence of the subaortic obstacle. This study was based on a retrospective observational study on all cases of subaortic stenosis operated on and collected in the cardiology department of the University Hospital of Sfax between January 1, 2010 and December 31, 2020. We studied the relationships between demographic, clinical, paraclinical variables and the recurrence of the subaortic obstruction in operated patients. We included 28 patients (18 men/10 women). At the time of diagnosis, symptoms were present in 67.85% of patients and a peak subaortic gradient ≥ 50 mmHg on echocardiography was present in 82.14% of patients. The mean age at the time of surgery was 10.43 years. Resection of the subaortic membrane was the most frequently used technique (46.4%). Operative mortality was zero. Recurrence, defined by the persistence of a peak subaortic gradient ≥ 50 mmHg in the medium and long term, was observed in 7 patients (25%), 6 of whom underwent reoperation. Recurrence was more frequent in patients with a preoperative peak subaortic gradient ≥ 70 mmHg compared to those with a peak gradient < 70 mmHg (60% versus 5.6%, P = 0.001) and in patients with a post-operative residual gradient ≥ 30 mmHg compared to those with a residual gradient < 30 mmHg (75% versus 5%, P < 0.001). Subaortic stenosis is a very polymorphic and progressive heart disease. The surgery provides good functional and hemodynamic results. Despite the late age of patients at diagnosis and surgery, our results were favorable in the short term, but recurrence was frequent in the medium and long term.

CLINICO EPIDEMIOLOGICAL PROFILE OF CORONARY ARTERY DISEASE IN THE YOUNG INDIVIDUALS

Background: In India as well as the rest of the world, cardiovascular disease (CVD) is the leading cause of death. The prevalence of coronary artery disease (CAD) is increasing in young adults as a result of the epidemiological change. Data on the epidemiological, clinical, and angiographic profiles of young individuals with ACS in India are scarce. Methods: The current prospective observational study was conducted in Department of Cardiology, SCB Medical College &amp; Hospital, Cuttack, Odisha, India with a high patient volume. A total of 30 cases (young patients 40 yrs. with acute myocardial infarction), 10 age-matched healthy controls, and 10 elderly patients (&gt;40 yrs.) with CAD were investigated, their histories thoroughly reviewed, and their clinical conditions thoroughly examined. Results: This study found that the average age of the cases was 34.4 years. HDL-C was lower than in the control group, the mean blood triglyceride and LDL-cholesterol increased in the case group. Serum Lp(a) levels were significantly higher in the case group (P=0.045) compared to controls and elderly CAD. Conclusion: The most typical ACS presentation in the young population was STE-ACS. The most prevalent risk factor was smoking. First medical contact and revascularization were delayed significantly, and the majority of the patients had single-vessel illness.

Angiographic Profile of Type 2 Diabetic Patients with ST Elevation Myocardial Infarction: A Cross-sectional Study

Introduction: Coronary atherosclerosis is common in diabetics, and it is diffuse in form, with multivessel involvement. It demonstrates the involvement of multiple vessels rather than a single vessel. Aim: To evaluate the angiographic profile of diabetic patients with ST Elevation Myocardial Infarction (STEMI). Materials and Methods: The present study was a cross-sectional study which enrolled 104 diabetic patients presenting with STEMI from December 2019 to March 2020. Seventy percent or more stenosis in any major coronary artery or its major branches (&gt;2.5 mm) was considered as significant. Results: Mean age of the patients was 55.61±11.32 years, with 75 subjects being males and 29 subjects being females. A total of 28 (26.92%) had Anterolateral Wall Myocardial Infarction (ALWMI), 4 (3.84%) had Anteroseptal Wall Myocardial Infarction (ASWMI) 39 (37.5%) had Anterior Wall Myocardial Infarction (AWMI), 1 (0.96%) had extensive AWMI, 2 (1.9%) had Inferolateral Wall Myocardial Infarction (ILWMI), while 30 (28.84%) patients had Inferior Wall Myocardial Infarction (IWMI). Furthermore, 51 (49.0%) were thrombolysed while 53 (50.96%) patients were non thrombolysed. Thirty eight (36.53%) had single vessel disease, 40 (38.46%) had double vessel disease, while 26 (25%) had triple vessel disease. Among these patients, Left Main Coronary Artery (LMCA) was involved in 3 (2.88%) of patients. Seventy three patients had a Glycated Haemoglobin (HbA1c) of greater than 8.5 and had multivessel involvement, whereas 31 had a HbA1c of less than 8.5. Major Adverse Cardiac Events (MACE) was observed during hospital stay in the form of death, recurrent myocardial infarction and cardiovascular stroke, which occurred in 20 (19.23%) patients of the total 104 diabetic patients. Conclusion: In the present study, the severity and extent of Coronary Artery Disease (CAD) and incidence of triple/multivessel disease was significantly high in diabetics. Diabetic patients with high HbA1c had more coronary vessel involvement. In this case, Coronary Artery Bypass Graft (CABG) is the mode of treatment

Clinicoinvestigative profile of ischemic heart disease patients admitted in tertiary care teaching hospital: A cross-sectional study

Background: Despite considerable progress in the diagnosis, management, and prevention of cardiovascular diseases, they are still the main cause of death globally. These diseases have assumed epidemic proportions in India as well. The angiographic profile of coronary artery disease patients, its clinical presentation, and risk factors differ worldwide. Aim and Objective: The aim of the study was to study the clinicoinvestigative profile of ischemic heart disease (IHD) patients seeking treatment at tertiary care teaching hospital of western Maharashtra. Materials and Methods: Institutional Ethics Committee approval was sought before initiation of the study. The present, descriptive, and cross-sectional study was conducted on IHD patients admitted for coronary angiography in cardiac recovery unit of tertiary care hospital. Detailed clinical data such as signs and symptoms, associated diseases, general, and systemic examination findings were collected. Results: Out of total 190 patients, 61.57% (117) were males and 38.42% (73) were females. Majority patients were between 41 and 60 years (78.94%) of age group. The most common chief complaint was chest pain (72%), followed by breathlessness (28%), palpitation (12%) sweating (18%), and vomiting (08%). Out of all 77.89% (148) had ST-segment elevation myocardial infarction (STEMI) while other hand 16.84% (32) and 04.73% (09) had non-ST-segment elevation myocardial and unstable angina, respectively. Conclusion: The present study concluded that IHD is more prevalent in males than females. STEMI was more common clinical presentation and cardiac failure (69.09%) was more prevalent complication among IHD.

Clinical presentation, risk factors, and coronary angiographic profile of very young adults (≤30 years) presenting with first acute myocardial infarction at a tertiary care center in Rajasthan, India

Introduction: Acute coronary syndrome (ACS) in very young adults with age ≤30 years is rare. In India, the prevalence of acute myocardial infarction (AMI) in this population is &lt;2%. ACS leads to significant effects on patient's psychology, morbidity, and increased financial burden when it occurs at this young age. Young patients with ACS on coronary angiography (CAG) show a relatively increased incidence of single-vessel disease and nonobstructive stenosis. Materials and Methods: This retrospective observational study was conducted at the Department of Cardiology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan. The medical records of very young adults (≤30 years of age) with first AMI between September 2019 to August 2021 were collected and analyzed. Results: Twenty-two very young adult patients aged ≤30 years were admitted with first AMI. Most of the patients were within the age group of 25–30 years. Mean patient age was 27.63 ± 2.03 years and 21 patients (95.4%) were men. Regarding the risk factors for coronary artery disease (CAD), smoking was the most common (54.5%) in young patients. Dyslipidemia and family history of premature CAD were present in 8 (36.3%) and 6 (27.2%) of patients. The most common symptom in patients was chest pain (90.9%). Obstructive CAD (vessel lumen stenosis ≥ 70%) was found in 18 (81.8%) patients. Conclusion: Very young adults presented with less extensive CAD as compared to elderly likely due to less atherosclerosis of the coronary arteries in them. The major modifiable risk factors in very young Indian population are smoking and dyslipidemia. Primary prevention by educating the public about the effects of smoking, unhealthy dietary habits, and sedentary lifestyle in early years of life may help to prevent the development of cardiac problems later in life.

Clinical and angiographic characteristics of smokers with acute ST elevation myocarial infarction undergoing primary angioplasty

Smoking is a well established cardiac risk factor. However, outcomes of primary percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI) in smokers are expected to be better than non-smokers patients. The purpose of this study was to determine clinical and angiographic profile of smokers with STEMI treated by primary PCI. We analyzed all consecutive patinets with STEMI hospitalized in Cardiology B deprtment of Fattouma Bourguiba university hospital between January 2000 and March 2017. A total of 352 patients were included in this study. Current smokers consist of 55.7% (196) of the total sample. Smokers were relatively younger as compared to non smokers with mean age of 57.2 ± 11.2 years vs. 63.6 ± 11 years (P < 0.001). A high majority of somkers were male (194 patients, 99%) and had lower prevalence of hypertension (39.4% vs. 62.5%, P < 0.001) and diabetes mellitus (44.3% vs. 61.2%, P = 0.03). Smokers had lower heart rate (68 ± 22.5bpm vs. 79.7 ± 21.7 bpm, P = 0.032) and systolic blood pressure (108 ± 22.9 mmHg vs. 119 ± 23 mmHg, P = 0.020) but they had similar left ventricular ejection fraction. On coronarography, smokers trended to have higher thrombus burden (P = 0.02) but less multivessel coronary artery disease (P = 0.037) and no-reflow phenomenon (P = 0.01). Smokers had better baseline and post procedural TIMI flow. Complications after angioplasty were less present in smokers (14.8% vs. 23.7%, P = 0.023). In-hospital mortality was not significatively higher in smokers (9.2% vs. 11.7%, P = 0.07). This study documents that the smoker's paradox may be explained by the younger age and fewer cardiovascular risk factors in smokers compared to non smokers.