Contrast-induced Nephropathy Research Articles

Zero-contrast Multivessel Percutaneous Coronary Intervention with Intravascular Ultrasound Guidance in a Patient with Acute-on-chronic Kidney Disease: Turn Hopeless into Hopeful

Contrast-induced nephropathy is one of the serious complications in patients with renal dysfunction who underwent administration of intravascular contrast media. To overcome this, an approach of drastic reductions in contrast volume and the use of intravascular ultrasound has been adopted in some clinical cases. This report emphasizes the potential benefits of zero-contrast multivessel percutaneous coronary intervention in a patient presenting with acute-on-chronic kidney disease.

Relation of uric acid and contrast-induced nephropathy in patients undergoing percutaneous coronary intervention

Relation of uric acid and contrast-induced nephropathy in patients undergoing percutaneous coronary intervention

Relationship between Lymphocyte to Monocyte Ratio and Contrast-Induced Nephropathy in Acute Coronary Syndrome patients treated with Percutaneous Coronary Intervention

Aim: This study aimed to evaluate lymphocyte to monocyte ratio (LMR) for risk of CIN in patients with ACS undergoing PCI. Methods: A total of 1001 ACS patients between 2017 and 2021 were included in the study. CIN was defined as an increase in serum creatinine level of ≥0.5 mg/dL or ≥ 25% above baseline within 72 hours after the procedure. Patients were divided into two groups: patients with and without CIN. Demographics, clinical risk factors, angiographic and laboratory parameters, CIN incidence, and other in hospital clinical outcomes were compared between two groups. Results: LMR at baseline was significantly lower in patients who developed CIN compared to those who did not (2.1±0.9 and 3.9±1.7, respectively; P < 0.001). In receiver operating characteristic analysis showed that at a cutoff of ≤3, the value of LMR exhibited 80.17 % sensitivity and 70.96% specificity for detecting CIN. At multivariate analyses, LMR ≤3 value (OR 5.525, 95% CI 2.518-12.123; P < 0.001) was one of significant independent predictors of CIN. Conclusion: Our study suggested that LMR level on admission was independently associated with the development of CIN after PCI in patients with ACS.

Comparative Analysis of Angiographic Parameters and Percutaneous Coronary Intervention Outcomes in Diverse Populations in Türkiye.

Due to the conflict in Syria since 2011, more than 3.5 million Syrian citizens reside in Türkiye. Because Syrian patients were underrepresented in previous studies on percutaneous coronary intervention (PCI) outcomes, we aimed to analyze the severity of coronary artery disease and in-hospital outcomes of PCI in this population. We retrospectively analyzed 142 Syrian patients who underwent PCI at our center between June 2020 and October 2022 and compared the data with that of age- and sex-matched Turkish patients (n = 271) who also underwent PCI. We assessed comorbidities, coronary anatomy features, procedural complications, and in-hospital cardiovascular outcomes (Major Adverse Cardiac and Cerebrovascular Events, MACCE). The mean age of the study population was 57 ± 12 years, with 15% being female. Clinical indication and coronary anatomy features did not differ between the groups. However, the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score was higher in Syrian patients compared to Turkish patients (16 [11-22] vs. 12 [8-20]; P < 0.001). Complex PCI rates, in-hospital bleeding and contrast nephropathy were similar in both groups. MACCE was comparable between Syrian and Turkish patients (13 [4.8%] vs. 13 [9.2%], P = 0.083). Comparable MACCE rates were observed in both ethnic groups undergoing PCI, despite a higher SYNTAX score in Syrian patients. Future research should investigate whether similar in-hospital MACCE rates are observed in other regions of Türkiye and whether long-term cardiovascular outcomes differ between Turkish and Syrian patients.

The use of intravascular contrast media in patients with impaired kidney function - joint clinical practice position statement of the Polish Society of Nephrology and the Polish Medical Society of Radiology.

Radiological procedures utilising intravascular contrast media (ICM) are fundamental to modern medicine, enhancing diagnostics and treatment in diverse medical fields. However, the application of ICM has been constrained in patients with compromised kidney function due to perceived nephrotoxic risks, called contrast-induced nephropathy or contrastinduced acute kidney injury. Historical evidence marked ICM as a possible contributor to kidney damage. This led to restrictive guidelines advocating limited ICM use in patients with impaired renal function, preventing crucial radiographic interventions in patients with acute kidney injury (AKI) and chronic kidney disease. Recent advances challenge these traditional views. In particular, no direct causal relationship has been confirmed between contrast admi-nistration and elevated serum creatinine concentrations in humans. Furthermore, contemporary research models and meta-analyses do not associate AKI with contrast usage. This paper, prepared by a cross-disciplinary team of nephrologists and radiologists, presents updated guidelines for ICM application amid renal function impairments, emphasising the reduced nephrotoxic risks currently understood and loosening the previous restrictive approach in patients with renal dysfunction.

Prognostic value of nutrition for contrast-induced nephropathy in patients undergoing peripheral vascular intervention.

Background: The objective was to examine the predictive value of malnutrition, assessed via the Controlling Nutritional status (CONUT) and Prognostic Nutrition Index (PNI) scores, in the development of contrast-associated acute kidney injury (CA-AKI) following peripheral vascular intervention (PVI).Methods: This retrospective cross-sectional observational study included the enrollment of 243 consecutive patients who underwent PVI. Patients were categorized into two groups based on the occurrence of CA-AKI.Results: Patients with CA-AKI had lower PNI scores and the PNI score was an independent predictor of CA-AKI development (Odds Ratio: 0.518, 95% CI: 2.295-0.908, p=0.021). Nomogram had higher discriminative ability than both PNI and CONUT scores and discriminative abilities were similar for PNI and CONUT scores.Conclusion: Malnutrition, as identified by the CONUT and PNI, was found to be associated with a high risk of CA-AKI development following PVI.

Contrast-Induced Nephropathy in Interventional Cardiology: Incidence, Risk Factors, and Identification of High-Risk Patients.

This study aimed to study contrast-induced nephropathy (CIN) or more recent nomenclaturecontrast-associated acute kidney injury (CI-AKI) in patientsundergoing percutaneous coronary procedures, evaluating CIN incidence, risk factors (RFs), and high-risk patients with CIN. Methods: This is a prospective, observational, unicentric trial of patients who underwent coronary angiography and/or percutaneous coronary intervention (PCI) in the University Hospital Center (UHC) "Mother Teresa" in Tirana, Albania, during 2016-2018. CIN was defined as an increase of 25% and/or by 0.5 mg/dL of serum creatinine (SCr) and high-risk patients with CIN as an increase by 50% and/or by 2 mg/dL and/or need for dialysis compared to the basal pre-procedural values. We evaluated RFs for CIN: preexisting renal lesion (PRL), heart failure (HF), age, diabetes mellitus (DM), anemia, and contrast quantity. Results: The incidence of CIN resulted in 14.4%. HF, PRL, and age ≥65 years resulted in independent RFs for CIN, whereas anemia, DM, and contrast quantity >100 mL did not. PRL proved to be the most important RF for CIN, whereas HF was the only independent RF for high-risk CIN patients. The incidence of CIN coincides with the results in the literature. PRL, HF, and age ≥65 years resulted in independent RFs for CIN; more and larger trials are needed to evaluate DM, anemia, and contrast quantity related to their impact on CIN. High-risk patients with CIN represent the most problematic patients of this pathology.

Comparing two risk scores for predictive ability of contrast-induced nephropathy development in patients presenting with chronic coronary syndrome

Comparing two risk scores for predictive ability of contrast-induced nephropathy development in patients presenting with chronic coronary syndrome

Рrevention of contrast-induced nephropathy during interventional treatment of acute coronary syndrome

The aim of the work was to determine the risk factors of contrast-induced nephropathy in patients with acute coronary syndrome and to evaluate the effectiveness of methods of its prevention. There were examined 62 patients admitted to the interventional cardiology department during 9 months of routine practice with a diagnosis of acute coronary syndrome and concomitant chronic kidney disease. Among them, 56.45% have diabetic nephropathy, 21% – hypertensive nephro­pathy, 19.35% – chronic pyelonephritis, 3.2% – gouty nephropathy. According to the stages of chronic kidney disease: I stage – 8.1%, II stage – 46.8%, III A stage – 30.6%, III B stage – 14.5% of patients. The control group consisted of 32 patients with acute coronary syndrome without kidney pathology. All patients underwent urgent percutaneous coronary intervention using a water-soluble low-osmolarity radiocontrast medium. The risk of contrast-induced nephropathy was determined according to the Mehran scale. Contrast-induced nephropathy was diagnosed by an increase in serum creatinine over 24-48 hours by &gt;25%. Prevention of contrast-induced nephropathy according to existing recommendations was carried out by prescribing early statin therapy and diuresis-controlled combined hydration in 22 patients with concomitant chronic kidney disease. Mathematical processing was performed using Statistica 8.0 software (StatSoft Inc, USA). Patients with chronic kidney disease had a high and very high risk of contrast-induced nephropathy in 19.4% and 3.2% of cases, among them in 91.6% of high and in 100% very high-risk contrast-induced nephropathy developed. Patients in the control group had a low to moderate risk, none of them developed contrast-induced nephropathy. It has been shown that the risk of contrast-induced nephropathy depends on the stage of chronic kidney disease and is associated with a decrease in the ejection fraction of the left ventricle (≤40%), acute left ventricle failure of the III and IV classes according to Killip, a decrease in diuresis in the first 12-24 hours after urgent percutaneous coronary intervention up to ≤0.6 ml/h/kg; in patients with diabetic nephropathy taking metformin 6-12 hours before the administration of the X-ray contrast medium and the glomerular filtration rate ≤45 ml/min./1.73 m2. In patients who underwent prevention of contrast-induced nephropathy in its entirety, its development was not registered.

Zero-Contrast Left Atrial Appendage Closure in Patients With Chronic Kidney Disease.

Left atrial appendage closure (LAAC) usually requires contrast medium during the procedure. However, patients with chronic kidney disease (CKD) are at high risk of developing contrast nephropathy. This study aimed to assess the safety and feasibility of zero-contrast LAAC in patients with CKD. Zero-contrast LAAC was attempted in 15 patients with CKD Stages 3b-5 who were not on hemodialysis. All procedures were performed successfully, without any periprocedural complications. At the 45-day follow-up, no device-related complications or acute kidney disease were observed. The strategy of zero-contrast LAAC in patients with CKD can be an acceptable option.

Assessing in-hospital mortality and predictors in Patients with contrast-induced nephropathy Following primary percutaneous coronary Intervention.

The contrast-induced nephropathy (CIN) is a common complication of primary percutaneous coronary intervention (PCI) it has been reported to be associated with an increased risk of mortality. The study reported the in-hospital mortality among patients who developed CIN after primary PCI. This descriptive cross-sectional study was conducted on a sample of consecutive who developed CIN after primary PCI at a tertiary care cardiac hospital in Karachi, Pakistan. The CIN was defined as either a relative increase of 25% or an absolute increase of 0.5 mg/dL in post -procedure serum creatinine within 72 hours. The in-hospital mortality status was recorded and clinical and demographic predictors of in-hospital mortality were identified with the help of binary logistic regression analysis. In the study sample of 402 patients, 74.1% (298) were male and the mean age of the study sample was 59.4±11.5 years. The in-hospital mortality rate was 9.7% (39). On multivar iable analysis, an increased risk of mortality was found to be independently associated with inferior wall myocardial infarction (IWMI) with right ventricular (RV) infarction, intra-procedure arrhythmias, and pump failure with an adjusted odds ratio of 3.63 [95% CI: 1.31-10.08; p=0.013], 5.53 [95% CI: 1.39-22.06; p=0.015], and 8.94 [95% CI: 3.99-20.02; p<0.001], respectively. In conclusion, there is a high rate of mortality for patients who develop CIN after primary PCI, and the risk of mortality is further aggravated by the presence of IWMI with RV infarction, intra-procedure arrhythmias, and pump failure.

Clinical Case of IVUS-Guided Coronary Artery Stenting in a Patient with Chronic Renal Failure

Introduction. An expanding number of indications for PCI in patients with coronary heart disease and severe concomitant pathology are accompanied by a growing number of patients with chronic renal failure. Contrast-induced nephropathy (CIN) is recognized as a severe complication, aggravating the course of the underlying disease, and, moreover, reducing the life expectancy of the patients. Modern intravascular imaging technologies are widely implemented in real clinical practice of endovascular surgery. In the context of increasing number of PCI performed in patients with severe concomitant pathology, the IVUS-guidance will improve the quality of stenting, and, importantly, lessen the risks of CIN due to the reduction in contrast volume. Materials and methods. The paper presents a clinical case of IVUSguided stenting of the right coronary artery without contrast agent in a patient with chronic kidney disease and the following diagnosis: “Coronary heart disease. Effort angina, class III (dyspnea as anginal equivalent). Balloon angioplasty and stenting of circumflex artery and LAD. Hyperlipidemia 2a. Atherosclerosis of the aorta, brachiocephalic and coronary arteries. Stage 3 hypertension. Controlled Hypertension. Level IV CVD risk. Type 2 diabetes mellitus. Target glycated hemoglobin is less than 7.5%. Grade 2 obesity, exogenous-constitutional. Renal microlithiasis. CKD stage 4 (GFR 29 ml/min/1.73m2). Cerebrovascular disease. Chronic cerebral ischemia.” Results and discussion. In the described clinical case, a complete myocardial revascularization was achieved using IVUS-guidance and minimal amount of contrast agent in a patient with severe CKD. The advantage of minimally invasive endovascular interventions in a complex category of patients, demonstrated by the case, implies expanded possibilities for providing high-tech care to patients with significant limitations in the use of contrast agents due to severe CKD with a high risk of CIN. Conclusion. Today, an increasing number of X-ray operating rooms in Russia are equipped with intravascular technologies, ensuring their wider use. The skills and knowledge in using IVUS imply rare application of contrast agents, thereby lessening the risk of CKD and, as a consequence, improving the prognosis of patients with reduced renal function and high risk of CKD.

Liposome-camouflaged iodinated mesoporous silica nanoparticles with high loading capacity, high hemodynamic stability, high biocompatibility and high radiopacity

Due to their low osmolality and high tolerability, the highly water-soluble nonionic iodinated contrast agents, such as Ioversol (IV), are widely used as clinical agents for CT imaging. However, their clinical applications still are severely limited by the rapid renal excretion, serious adverse effects especially contrast-induced nephropathy and inefficient targetability. Various nanocarriers have demonstrated tremendous potential for achieving high imaging efficiency and low side effects. However, few nanoparticulate contrast agents can simultaneously integrate the desirable functions for imaging, including high loading capacity of iodine, high structure stability for systemic circulation, high biocompatibility and high radiopacity. Herein, we designed and prepared a kind of new radiopaque liposome-camouflaged iodinated mesoporous silica nanoparticles (OIV-MSNs@Liposomes) as contrast agents in CT imaging. Their composition, structure, morphology, biocompatibility and physicochemical properties as well as in vitro radiopacity were investigated in detail. The results indicated that OIV-MSNs@Liposomes can integrate their individual advantages of liposomes and MSNs, thus exhibiting great potential for use in the CT imaging. Considering the simple preparation process and readily available starting materials as well as enhanced biosafety and high performance in X-ray attenuation, the strategy reported here offers a versatile route to efficiently deliver highly water-soluble nonionic iodinated contrast agents for enhanced CT imaging, which are unattainable by traditional means.

Renal outcomes after contrast exposure in patients with diabetes who use sodium-glucose cotransporter 2 inhibitors.

Contrast-induced nephropathy has become increasingly prevalent as the age and prevalence of comorbidities in the general population have increased. Most cases of contrast-induced nephropathy are reversible; however, some may progress to acute kidney disease, and subsequently, to chronic kidney disease. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are known for their renoprotective effects. However, whether the use of these inhibitors affects the risk of contrast-induced kidney injury remains unclear. Data were collected from the Taipei Medical University Clinical Research Database. We included patients with diabetes who had contrast exposure between 2016 and 2020 because of computed tomography or coronary angiography. The primary outcome was the risk of a major adverse kidney event (MAKE), which encompassed acute kidney disease, chronic kidney disease progression, and the need for renal replacement therapy. Overlap weighting was performed to reduce the effects of potential confounders. This study included 12 421 patients, who were divided into two groups: SGLT2i users (n = 920) and nonusers (n = 11 501). The follow-up period after contrast exposure was 6months. The risk of a MAKE was lower in SGLT2i users than in nonusers (incidence, 36.9 vs. 49.9 per 1000 person-months, respectively; P = .0011). Furthermore, the incidence of acute kidney disease or chronic kidney disease progression was significantly lower in the SGLT2i users than in nonusers. However, no significant between-group difference was noted in the incidence of other MAKEs. SGLT2i may be safely used in diabetic patients needing contrast exposure. The risk of a MAKE may be lower in SGLT2i users than in nonusers.

Intravascular Imaging in Ultra-Low or Zero-Contrast Percutaneous Coronary Interventions: The Time Is Now?

Ultra-low contrast percutaneous coronary interventions (ULPCIs) are a novel field of interventional cardiology, aiming to reduce the risk of contrast-induced nephropathy (CIN), which is a well-described adverse event after angiography. CIN is a well-described adverse event following PCI, especially in high-risk patients, i.e., patients with an already deteriorating renal function or chronic kidney disease, as well as patients of advanced age or requiring an increased amount of contrast during their intervention. Among the techniques described for ULPCI procedures, intravascular imaging guidance seems a promising option, as it allows lesion recognition and characterization, stent implantation, and PCI optimization. Intravascular ultrasound (IVUS) is the modality most commonly used, as it does not require contrast injection, contrary to optical coherence tomography (OCT). Several clinical trials, assessing IVUS in the context of ULPCI, have shown that it can be safely used in this setting while offering a substantial reduction in contrast media volume, as well as renal adverse outcomes. This review aims to describe the need for ULPCI and technical considerations regarding the use of intravascular imaging in this setting, as well as analyze the available evidence from clinical trials regarding the safety and efficacy of IVUS-ULPCI, in order to provide a comprehensive summary for practicing physicians.

CONTRAST-INDUCED NEPHROPATHY IN POST-COVID-19 PATIENTS

Abstract. Introduction. Contrast-induced nephropathy is a serious cause of acute kidney injury and represents an urgent problem in clinical practice. Until recently, there are contradictions in the understanding of many aspects of contrast-induced nephropathy. However, the current situation with using CAs in patients with COVID-19, thus causing contrast-induced nephropathy, has become an urgent issue for clinical physicians and radiologists. Aim of this study is to review some up-to-date information on the use of newer and less nephrotoxic drugs among post-COVID-19 patients with a previous renal impairment. Material and Methods. Topical studies published on studying contrast- induced nephropathies in post-COVID-19 patients have been reviewed herein. Results and Discussion. In case of developing the acute renal failure syndrome caused by using CAs in past-COVID-19 patients, first it is necessary to exclude alternative (non-contrast-induced) causes of its occurrence, such as thromboembolism syndrome that may develop upon angiography, ischemic nephropathy, nephrotoxic effects. Upon administration of the X-ray ca, a short-term increase in creatinine levels is possible after 24 hours, but this does not mean the development of contrast-induced nephropathy. Conclusions. To prevent the development of contrast-induced nephropathies, patients must be adequately hydrated. Nephrotoxic drugs should be discontinued at least 24 hours before ca administration. Moreover, the choice of a suitable ca is important.

Preventive effect and mechanism of compound Danshen dripping pills on contrast-induced nephropathy after percutaneous coronary interventional.

Contrast-induced nephropathy (CIN) is one of the most common complications after coronary stent implantation due to the extensive development of coronary catheterization technology. Compound Danshen dripping pills (CDDP) are clinically used as cardiovascular drugs, relieving systemic inflammatory response. Previous studies have observed that CDDP can decrease CIN incidence after coronary stent implantation with uncertain effectiveness. We conducted a prospective, randomized, single-center, single-blind, controlled trial. We enrolled patients 18 years and older with unstable angina pectoris and NSTEMI who underwent PCI at the Tianjin Chest Hospital between November 1, 2021, and November 31, 2022, and followed for 30 days. Patients were randomized to CDDP and hydration therapy (10 capsules three times/day; N = 411) or hydration only (N = 411). The primary outcome was the contrast nephropathy incidence, defined as an elevation in serum creatinine by more than 25% or 44 μmol/L from baseline within 48-72 h of contrast exposure. Secondary outcomes included major adverse cardiovascular events post-surgery and during follow-up. After 48 h of operation, the two groups had statistical significance in Scr and BUN values (80.0 ± 12.59 vs. 84.43 ± 13.49, P < 0.05; 6.22 ± 1.01 vs. 6.40 ± 0.93, P < 0.05). The difference in Scr in 72 h between the two groups was statistically significant (76.42 ± 10.92 vs. 79.06 ± 11.58, P < 0.05). The CIN incidence was significantly lower in the CDDP group than in the hydration group. The CIN risk was significantly elevated in patients with LVEF <50%, contrast volume ≥160 ml, and hypertension, after 48 and 72 h of operation. The serum inflammation index levels NGAL, TNF-α, oxidative stress indexes SOD, and MDA significantly differed between the two groups. However, there was no significant difference in serum apoptosis indexes Bax, Bcl-2, and Casepase-9. CDDP pre-treatment could prevent contrast-induced nephropathy. Inflammatory response and oxidative stress could be significant in the CDDP mechanism.

Administration of N-acetylcysteine for contrast-induced acute kidney injury; an updated mini-review

Contrast-induced acute kidney injury (CI-AKI) is a potential complication of medical imaging procedures that use contrast media. It is important to identify and manage risk factors for contrast-induced nephropathy and to monitor patients for signs of renal damage after contrast administration. N-acetylcysteine (NAC) can prevent CI-AKI through multiple mechanisms of action, including reducing oxidative stress, improving renal hemodynamics, reducing inflammation, reducing apoptosis and fibrosis, reducing oxidative stress-induced DNA damage, reducing tubular cell injury, and reducing renal tubular cell apoptosis. However, the exact mechanisms of action may vary based on the specific study or context. Further research is needed to fully elucidate the molecular mechanisms of NAC in preventing CI-AKI.

Application of systemic inflammation score for the assessment of contrast-induced acute kidney injury; a review

Contrast-related acute renal failure is a multifactorial condition that involves oxidative stress, inflammation, and direct tubular toxicity. Risk factors for contrast-induced nephropathy comprise pre-existing kidney dysfunction, diabetes mellitus, advanced age, congestive heart failure, hypotension, anemia, and volume depletion. Preventive measures include identifying high-risk patients and implementing preventive measures such as adequate hydration, minimizing contrast use, and avoiding using contrast media in patients with pre-existing renal dysfunction. The systemic inflammation score is a promising tool for predicting contrast-associated acute kidney injury (CA-AKI) in patients undergoing contrast-enhanced imaging procedures. Further studies are needed to validate the use of SIS in clinical practice and to better understand the underlying mechanisms of inflammation in (CA-AKI).

In Hospital Outcome of Pharmaco-invasive Therapy versus Primary PCI In ST-segment elevation Myocardial Infarction in Dhaka, Bangladesh

Background &amp; Objectives: In many low middle income countries (LMIC), it is difficult to treat patients with ST-segment elevation Myocardial Infarction (STEMI) with timely PPCI. Thus, many undergo fibrinolysis. Whether early fibrinolysis followed by timely coronary angiography provides a clinical outcome similar to that of primary percutaneous coronary intervention (PPCI) after acute STEMI in LMIC settings remains a question. In this observational study we primarily aimed to compare in-hospital outcomes of primary PCI versus pharmaco-invasive strategy (immediate fibrinolysis followed by coronary angiography with possible PCI within 3-24 hours) for reperfusion in eligible patients with STEMI at a tertiary cardiac care center. Methods: This prospective observational study was done in Ibrahim Cardiac Hospital &amp; Research Institute, Dhaka from April 2022 to July 2022 where consecutive patients presenting with STEMI were enrolled and divided into two groups: those who underwent primary PCI (Group-I) and those who underwent immediate fibrinolysis with subsequent coronary angiography with PCI within 3 to 24 hours (Group-II). The main outcomes analyzed were all-cause death, cardiogenic shock, acute left ventricular failure, life threating arrhythmia, acute stent thrombosis, CVD, Contrast induced nephropathy (CIN), re-infarction, target-vessel revascularization, and major bleeding up to 7 days. Results: A total 122 patients presented with acute STEMI, 61 in each group. One group underwent primary PCI and another group treated with fibrinolysis by tenecteplase. The mean age of the studied patients was 53.86±9.72 years (range 18-75 years). Eighteen percent of patients presented with Extensive Anterior MI,19.7% showed Anterior MI, 21.3% showed Antero-septal MI, 21.3% showed Inferior MI, 9.8% showed Inferior with posterior and 3.3% showed Lateral MI. 35.5% had Single vessel disease, 31.1% had double vessel disease,28.7% had triple vessel disease, LM with LAD was 0.8% and 0.8% had recanalized infarct related artery in both groups overall. In group-I 45.9% of PPCI were undertaken in LAD and 32.8% patient. of group-II was done PCI in LAD. There were no significant differences between two groups in primary outcome and mortality. Conclusion: Immediate fibrinolysis followed by coronary angiography within 3-24 hours resulted in similar short-term outcomes in patients with STEMI compared to PPCI. Our study suggests that, compared with PPCI, fibrinolysis performed in the hospital setting is associated with similar mortality rates, acute CVD, CIN and acute left ventricular failure in with PPCI than STEMI. University Heart Journal 2023; 19(1): 10-14