Percutaneous Coronary Angiography Research Articles

A Comprehensive Approach to the Treatment of Ischemic Heart Disease in Patients with Cardiorenal Metabolic Syndrome

Ischemic heart disease (IHD) remains the leading cause of mortality and disability due to cardiovascular diseases. IHD often manifests itself as stenosing atherosclerosis of the coronary arteries, which can be treated surgically or interventionally. However, chronic coronary syndromes with intact coronary vessels are a serious problem for modern medicine. Coronary microvascular dysfunction is accompanied by impaired coronary blood flow reserve, which leads to myocardial ischemia and angina pectoris, despite the absence of significant coronary artery stenosis. The objective: to study the mechanisms of myocardial ischemia in patients with coronary artery disease and cardiorenal metabolic (CRM) syndrome and to analyze the effectiveness of different treatment approaches depending on the identified mechanisms. Materials and methods. The study included 104 patients with CRM syndrome who underwent examination at the State Institution “The Scientific and Practical Medical Center of Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine” during 2023. Various forms of CHD were detected in the patients. Exercise stress tests were used to diagnose myocardial ischemia. Patients with confirmed stenosing atherosclerosis by percutaneous coronary angiography received appropriate interventional treatment. Microvascular angina was suspected in 21 patients without significant coronary artery lesions. The coronary blood flow reserve index was determined by echocardiography with intravenous administration of dipyridamole. Results. It was determined that of 21 patients with microvascular angina who received a comprehensive treatment including nicorandil, 20 (95.2%) persons were free of ischemic symptoms after 4 weeks. One patient had a decrease in complaints, but discomfort during exercise continued, which was successfully corrected after increasing the dose of nicorandil. Of 83 participants with CRM syndrome, CHD, and stenosing atherosclerosis who underwent coronary angiography, 74 (89.1%) patients had no ischemic symptoms and negative exercise test results after 28 days. In 9 cases ischemia persisted and a positive/doubtful exercise stress test was found. These patients were additionally prescribed nicorandil at a dose of 10 mg 2 times a day, which led to the disappearance of symptoms of angina pectoris and negative results of the exercise test at an additional re-examination after 7 days. Conclusions. In patients with CRM syndrome, the causes of ischemic heart disease were stenosing atherosclerosis (71.2%), microvascular angina (20.2%) and their combination (8.6%). Interventional treatment and nicorandil are effective in the treatment of coronary artery disease with different mechanisms, especially in cases of their combination.

Comparing distal and proximal radial access for percutaneous coronary intervention and angiography: a comprehensive meta-analysis and systematic review of randomized controlled trials.

Distal radial access (DRA) through the anatomical snuff-box is a novel technique for coronary procedures. Emerging evidence suggests that DRA is associated with a lower risk of certain complications compared to proximal radial access (PRA). A systematic review was conducted to compare clinical and procedural outcomes between both access sites for coronary angiography and percutaneous coronary intervention. We searched PubMed, Web of Science, Cochrane, and Scopus to identify relevant randomized controlled trials. We included 23 randomized controlled trials enrolling 10 062 patients (DRA group: 5042; PRA group: 5020) in this review. DRA was associated with a lower risk for radial artery occlusion (RAO) at the longest reported follow-up [risk ratio (RR): 0.30, P < 0.00001], in-hospital RAO (RR: 0.28, P < 0.00001), any bleeding (RR: 0.40, P = 0.04), hand clumsiness (RR: 0.05, P < 0.00001), and shorter time to hemostasis [mean difference (MD): -40.93, P < 0.00001]. However, DRA showed a higher access failure rate (RR = 2.64, P < 0.00001), longer access time (MD = 0.77, P < 0.00001), more puncture attempts (MD: 0.60, P < 0.0001), and greater access-related pain [standardized mean difference (SMD) = 0.23, P = 0.02]. Both approaches were comparable in terms of major adverse cardiac events (RR = 0.74, P = 0.60), and hand function (SMD = -0.05, P = 0.68). DRA is a safe alternative to PRA for coronary procedures, with a lower risk of complications, including RAO. However, it is limited by access-related challenges.

Predictive performance of machine learning models for kidney complications following coronary interventions: a systematic review and meta-analysis.

Acute kidney injury (AKI) and contrast-induced nephropathy (CIN) are common complications following percutaneous coronary intervention (PCI) or coronary angiography (CAG), presenting significant clinical challenges. Machine learning (ML) models offer promise for improving patient outcomes through early detection and intervention strategies. A comprehensive literature search following PRISMA guidelines was conducted in PubMed, Scopus, and Embase from inception to June 11, 2024. Study characteristics, ML models, performance metrics (AUC, accuracy, sensitivity, specificity, precision), and risk-of-bias assessment using the PROBAST tool were extracted. Statistical analysis used a random-effects model to pool AUC values, with heterogeneity assessed via the I2 statistic. From 431 initial studies, 14 met the inclusion criteria. Gradient Boosting Machine (GBM) and Support Vector Machine (SVM) models showed the highest pooled AUCs of 0.87 (95% CI: 0.82-0.92) and 0.85 (95% CI: 0.80-0.90), respectively, with low heterogeneity (I2 < 30%). Random Forest (RF) had a similar AUC of 0.85 (95% CI: 0.78-0.92) but significant heterogeneity (I2 > 90%). Multilayer perceptron (MLP) and XGBoost models had moderate pooled AUCs of 0.79 (95% CI: 0.74-0.84) with high heterogeneity. RF showed strong accuracy (0.83, 95% CI: 0.70-0.96), while SVM had balanced sensitivity (0.69, 95% CI: 0.63-0.75) and specificity (0.73, 95% CI: 0.60-0.86). Age, serum creatinine, left ventricular ejection fraction, and hemoglobin consistently influenced model efficacy. GBM and SVM models, with robust AUCs and low heterogeneity, are effective in predicting AKI and CIN post-PCI/CAG. RF, MLP, and XGBoost, despite competitive AUCs, showed considerable heterogeneity, emphasizing the need for further validation.

Investigating healthcare pathway management and inequalities using a novel data source: An observational study using linked, routinely collected data from a digital health system

ABSTRACT Acute coronary syndromes (ACS) are a common cause of morbidity in the UK. The mainstay of treatment is percutaneous coronary angiography (PCA) +/− percutaneous coronary intervention (PCI). In the Northwest sector of Greater Manchester and Salford, PCI labs are shared between hospitals and trusts, co-ordinated by a bespoke online administration system which routinely collects clinical and demographic data for patients requiring angiography. We are not aware of data from such systems previously being analysed and used to guide health service management. We isolated and linked this dataset for the year 2018 with other admission data to explore variations in the time spent on this treatment pathway (from admission to angiography). Unadjusted analysis shows pathway time is affected by weekday, date of admission, age and gender. Regression analysis using demographic and clinical variables shows a persisting disparity according to admission site and gender, with ethnic disparities that are challenging to explain. Although an observational study, the dataset is collected prospectively and has excellent granularity. As well as demonstrating feasibility of use in investigating equality of access and treatment, we demonstrate its utility for service development, management, and improvement. These methods are easily replicable across other clinical systems and specialties.

Incidence and Predictors of Early and Late Radial Artery Occlusion after Percutaneous Coronary Intervention and Coronary Angiography: A Systematic Review and Meta-Analysis

Introduction: Trans-radial access for coronary angiography and percutaneous coronary intervention (PCI) has gained popularity due to its advantages over the traditional transfemoral approach. However, radial artery occlusion (RAO) remains a common complication following trans-radial procedures. This study aimed to investigate the incidence of early and late RAO along with their risk factors. Methods: Six databases, Medline (Ovid), National Library of Medicine (MeSH), Cochrane Database of Systematic Reviews (Wiley), Embase, Scopus, and Global Index Medicus, were searched. The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted and analyzed. Using a random-effect model, the primary endpoint was the overall incidence of RAO after invasive coronary procedures. Subgroup analysis and meta-regression were also performed to identify possible predictors of RAO. Results: A total of 41 studies with 30,020 patients were included. The overall incidence of RAO was 13% (95% CI = 0.09–0.16). The incidence of early RAO (within 24 h) was 14% (95% CI = 0.10–0.18) in 26 studies, while the incidence of late RAO (after 24 h) was 10% (95% CI = 0.04–0.16) in 22 studies. The average incidence rates of early RAO in studies with catheter sizes of &lt;6 Fr, 6 Fr, and &gt;6 Fr were 9.8%, 9.4%, and 8.8%. The overall effect size of female gender as a predictor was 0.22 with a 95% CI of 0.00–0.44. Age was a potential predictor of early RAO (B = 0.000357; 95% CI = −0.015–0.0027, p: 0.006). Conclusions: This meta-analysis provides essential information on the incidence of early (14%) and late (10%) RAO following angiographic procedures. Additionally, our findings suggest that female sex and age are possible predictors of RAO. A larger catheter, especially (6 Fr) and hemostatic compression time &lt;90 min post-procedure, substantially reduced the incidence of RAO. The use of oral anticoagulation and the appropriate dosage of low-molecular-weight heparin (LMWH) does reduce RAO, but a comparison between them showed no statistical significance.

Sexual Dysfunctions and Psychiatric Correlates among a Sample of Egyptian Female Patients with Ischemic Heart Diseases Following Percutaneous Coronary Intervention

Abstract Background Female sexual dysfunction is a wide range of illnesses that can affect a patient's capacity to respond to or enjoy sexual activity in orgasm, interest/arousal, or Genito-pelvic pain/penetration which occurs most of the time and represents a problem to the patient (in DSM5 TR). Aim of the Work To assess the correlation between ischemic heart disease and female sexual function in patients who underwent percutaneous female intervention in the last year. To study the risk factors of female sexual dysfunction after percutaneous coronary angiography in group 1. To assess the correlation between ischemic heart disease and depression, anxiety and post-traumatic stress disorder in patients who underwent percutaneous female intervention in the last year Patients and Methods This study is a comparative cross-sectional study. This study conducted at cardiology outpatient Clinics at Ain Shams University Hospital. Ain Shams University is in Cairo and serves a catchment area of about the third of Greater Cairo. It serves both urban and rural areas, including areas around Greater Cairo as well. The Study period from March 2023 till end of the study. Results Both groups showed 100% of cases have sexual dysfunction regardless undergoing intervention or not with no statistical difference between both group neither regarding the total score or each domain score and this may be explained by presence of worsening factors in both groups like presence of chest pain, most of patients are menopausal (60% in each group) with the most important factors seen in our study is the cultural concepts among women to have sexual relation in presence of chronic disease like ischemic heart disease and this has been shown when looking deeply in the patients we will found 7 patients (23.3%) who underwent the intervention scored only 2 in FSFI total score which is the minimal (indicating lack of any sexual activity in spite of presence of partner) with the same number seen in the group which didn’t undergo the intervention this rate of having sexual activity. Conclusion Comprehensive examination of the impact of sexual dysfunction, PTSD, depression, and anxiety in patients with ischemic heart disease, and how these factors interrelate with each other as well as with the intervention of stenting or angioplasty. The finding that sexual dysfunction is universally present across your study groups, regardless of intervention, underscores the complexity of sexual health in the context of chronic diseases.

TCT-996 A Comparative Study of Dorsal Radial Artery Access vs Classical Radial Artery Access for Percutaneous Coronary Angiography

TCT-996 A Comparative Study of Dorsal Radial Artery Access vs Classical Radial Artery Access for Percutaneous Coronary Angiography

Outcomes and relevance of emergency percutaneous coronary angiography and intervention after resuscitated cardiac arrest: a retrospective study

BackgroundIn patients resuscitated from cardiac arrest and displaying no ST-segment elevation on initial electrocardiogram (ECG), recent randomized trials indicated no benefits from early coronary angiography. How the results of such randomized studies apply to a real-world clinical context remains to be established.MethodsWe retrospectively analyzed a clinical database including all patients 18 yo or older admitted to our tertiary University Hospital from January 2017 to August 2020 after successful resuscitation of out-of-Hospital (OHCA) or In-Hospital (IHCA) cardiac arrest of presumed cardiac origin, and undergoing immediate coronary angiography, regardless of the initial rhythm and post-resuscitation ECG. The primary outcome of the study was survival at day 90 after cardiac arrest. Demographic data, characteristics of cardiac arrest, duration of resuscitation, laboratory values at admission, angiographic data and revascularization status were collected. Comparisons were performed according to the initial ECG (ST-segment elevation or not), and between survivors and non-survivors. Variables associated with the primary outcome were evaluated by univariate and multivariate regression analyses.ResultsWe analyzed 147 patients (130 OHCA and 17 IHCA), including 67 with STEMI and 80 without STEMI (No STEMI). Immediate revascularization was performed in 65/67 (97%) STEMI and 15/80 (19%) no STEMI. Day 90 survival was significantly higher in STEMI (48/67, 72%) than no STEMI (44/80, 55%). In the latter patients, survival was not influenced by the revascularization status. In univariate and multivariate analyses, lower age, a shockable rhythm, shorter durations of no flow and low flow, and a lower initial blood lactate were associated with survival in both STEMI and no STEMI. In contrast, metabolic abnormalities, including lower initial plasma sodium and higher potassium were significantly associated with mortality only in the subgroup of no STEMI patients.ConclusionsOur results, obtained in a real-world clinical setting, indicate that an immediate coronary angiography is not associated with any survival advantage in patients resuscitated from cardiac arrest of presumed cardiac etiology without ST-segment elevation on initial ECG. Furthermore, we found that some early metabolic abnormalities may be associated with mortality in this population, which should deserve further investigation.

Prediction of The Patients at Risk for Development Hematoma After Percutaneous Coronary Angiography: A Nursing Decision Support Model Pilot Study

The study aimed to develop a nursing clinical decision support model using the machine learning method, which is one of the important fields today, to identify patients with risk of hematoma development after Percutaneous Coronary Intervention and to help plan appropriate nursing interventions. In this study, the data of 100 patients with myocardial infarction was used in the development of the decision support model. R open-source programming language was used for statistical analysis of the data and the random forest method, one of the machine learning methods was used for the development of the model. The result of this pilot study, a nursing decision support model with a sensitivity of 69% and a specificity of 64% was developed with the Random forest method using 24 features regarding the demographic, laboratory, and percutaneous coronary intervention procedures of the patients.

Clinical Practice Patterns for Transradial Coronary Artery Catheterisation in Australian and New Zealand: Mixed-Methods Survey and Interview Study

While there has been an increase in the use of the transradial approach when performing percutaneous coronary angiography and intervention, there is evidence of variations in international practice. Ensuring that operators' practices are supported by evidence is important to ensure optimal outcomes. Interventional cardiologists and advanced trainees completed a cross-sectional survey followed by semi-structured interviews to map current practices for transradial coronary artery procedures in Australia and New Zealand and explore factors that influence clinical decision-making around procedural practice. The right radial artery was the preferred access site (88%). Over a third (37%) of the participants indicated that they tested the hand circulation pre-procedure. Over a quarter of respondents (28.6%) reported that they would carry out transradial procedures regardless of the patient's coagulation status. Most participants (77.8%) described radial artery spasm in around 10% of transradial procedures performed. Only 62% of participants assessed for radial artery occlusion post-catheterisation. Interview data revealed four themes that guided clinical decision-making, namely (1) Decision-making based on research, (2) Using clinical experience, (3) Being led by their training, and (4) Individual patient factors. This study has demonstrated that despite clinical guidelines, substantial practice variation exists in transradial coronary artery catheterisation across Australia and New Zealand. The variation in practice and factors impacting clinical decision-making highlight a need for future strategies to optimise evidence translation and implementation across clinical settings.

Baseline coronary artery stenosis severity is an independent predictor of subsequent poor sleep quality in patients with acute coronary syndrome.

To investigate the relationship between coronary artery lesion severity determined using the baseline SYNTAX score and sleep problems that might occur after discharge determined using the Pittsburgh Sleep Quality Index (PSQI). This prospective study included patients with first acute coronary syndrome (ACS) who underwent percutaneous coronary angiography between February 2019 and August 2019. The severity of coronary artery stenosis was classified according to coronary angiography and SYNTAX scores. Patients were grouped as those with a SYNTAX score of ≤22 and >22. Sleep quality after discharge was classified according to the PSQI. PSQI ≤5 represented good sleep quality, and PSQI >5 represented poor sleep quality. Univariate and multivariate logistic regression was used to investigate the relationship between sleep quality and coronary artery stenosis severity. A total of 424 patients were included in the study. Of these, 294 (69.34%) had a SYNTAX score of ≤22 and 130 (30.66%) had a SYNTAX score of >22. The mean age of all patients was 60.37 ± 12.23 years, 59.69 ± 11.85 years in the SYNTAX ≤22 groups and 61.90 ± 12.98 years in the SYNTAX >22 group (P = 0.086). The majority (78.54%) of the patients were male and there was no significant difference between the SYNTAX ≤22 group and the SYNTAX >22 group in terms of sex distribution (P = 0.383). According to the univariate logistic regression analysis, age (P = 0.014), diabetes (P = 0.027), left ventricular ejection fraction (P = 0.001), estimated glomerular filtration rate (P = 0.039), creatine kinase MB (P = 0.040) and SYNTAX scores (P < 0.001) were significantly associated with high PSQI global scores (>5). However, according to the multivariate logistic regression analysis results, high (>22) SYNTAX scores were the only factor independently associated with the high (>5) PSQI global scores [odds ratio, 3.477; 95% confidence interval (CI), (2.190-5.522); P < 0.001]. Complete revascularization group had significantly higher sleep latency and sleep duration time, sleep efficiency and the percentage of patients with PSQI global score of ≤5 than the incomplete revascularization group (P < 0.001 for all). Among patients with ACS, those with high SYNTAX scores should be monitored more carefully for sleep disorders that may occur later.

Effects of Continuous Precision Nursing Model on Knowledge, Attitudes, and Practices (KAP) Behavior and Cardiac Function in Patients after Percutaneous Coronary Angiography and Stent Implantation

Objective: To explore the impact of a continuous precision nursing model on patients’ Knowledge, Attitudes, and Practices (KAP) and cardiac function during the nursing process of patients undergoing percutaneous coronary angiography and stent implantation. Methods: Ninety patients who underwent percutaneous coronary angiography and stent implantation in our hospital from April 2022 to April 2023 were selected and randomly divided into the control group (45 cases), in which routine nursing support was carried out during the treatment process, and the observation group (45 cases), in which continuous precision nursing model was carried out during the treatment process. Comparisons were made between the two groups of patients on their KAP, cardiac function, and quality of life during recovery. Results: There was no difference in the left ventricular ejection fraction (LVEF), cardiac output (CO), and cardiac index (CI) levels before intervention. After the intervention, the levels of cardiac function in the observation group were higher than those of the control group (P &lt; 0.05). There was no difference in the Exercise of Self-Care Agency (ESCA) self-care ability scale scores before the intervention. After the intervention, the observation group had higher ESCA scores than the control group (P &lt; 0.05). Conclusion: Implementation of a continuous precision nursing model in the care of patients undergoing percutaneous coronary angiography and stent implantation improved the patient’s cardiac function, and KAP, and promoted recovery.

Electrocardiographic patterns and clinical outcomes of acute coronary syndrome cardiogenic shock in patients undergoing percutaneous coronary intervention — A propensity score analysis

ObjectivesTo determine the influence of presenting electrocardiographic (ECG) changes on prognosis in acute coronary syndrome cardiogenic shock (ACS-CS) patients undergoing percutaneous coronary angiography (PCI). BackgroundThe effect of initial ECG changes such as ST-elevation myocardial infarction (STEMI) versus non-STEMI among patients ACS-CS on prognosis remains unclear. MethodsWe analysed data from consecutive patients with ACS-CS enrolled in the Victorian Cardiac Outcomes registry between 2014 and 2020. Inverse probability of treatment weighting analysis (IPTW) was used to assess the effect of ECG changes on 30-day mortality. ResultsOf 1564 patients with ACS-CS who underwent PCI, 161 had non-STEMI and 1403 had STEMI on ECG. The mean age was 66 ± 13 years, and 74 % (1152) were males. Patients with non-STEMI compared to STEMI were older (70 ± 12 vs 65 ± 13 years), had higher rates of diabetes (34 % vs 21 %), prior coronary artery bypass graft surgery (14 % vs 3.3 %), peripheral arterial disease (10.6 % vs 4.1 %, p < 0.01), and lower baseline eGFR (53.8 [37.1, 75.4] vs 65.3 [46.3, 87.8] ml/min/1.73m2), all p ≤ 0.01. Non-STEMI patients were more likely to have a culprit left circumflex artery (29 % vs 20 %) and more often underwent multivessel percutaneous coronary intervention (30 % vs 20 %) but had lower rates of out-of-hospital cardiac arrest (21 % vs 39 %), all p ≤ 0.01. Propensity score analysis with IPTW confirmed that non-STEMI ECG was associated with lower odds for 30-day all-cause mortality (OR 0.47 [0.32, 0.69], p < 0.001), and 30-day major adverse cardiovascular and cerebrovascular events (OR 0.48 [0.33, 0.70]). ConclusionsIn patients undergoing PCI, Non-STEMI as compared to STEMI on index ECG was associated with approximately half the relative risk of both 30-day mortality and 30-day MACCE and could be a useful variable to integrate in ACS-CS risk scores.

Distal Versus Proximal Radial Arterial Access for Percutaneous Coronary Angiography and Intervention: Updated Meta-Analysis of Randomized Controlled Trials

Radial artery occlusion (RAO) is a major impediment to reintervention in patients who underwent proximal transradial access (p-TRA) for coronary catheterization. Distal transradial access (d-TRA) at the level of snuffbox distal to the radial artery bifurcation is a novel alternative to p-TRA. We conducted an updated meta-analysis of all available randomized controlled trials (RCTs) to compare the incidence of RAO between p-TRA and d-TRA, along with access site-related complications. PubMed, Web of Science, and Google Scholar were searched for RCTs published since 2017 to October 2023 comparing d-TRA and p-TRA for coronary angiography and/or intervention. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals were calculated using the random-effects model for procedural and clinical outcomes for the 2 approaches. A total of 18 RCTs with 8,205 patients (d-TRA n = 4,096, p-TRA n = 4,109) were included. The risk of RAO (RR 0.31, 0.21 to 0.46, p ≤0.001) and time to hemostasis (minutes) (MD -51.18, -70.62 to -31.73, p <0.001) was significantly lower in the d-TRA group. Crossover rates (RR 2.39, 1.71 to 3.32, p <0.001), access time (minutes) (MD 0.93, 0.50 to 1.37, p <0.001), procedural pain (MD 0.46, 0.13 to 0.79, p = 0.006), and multiple puncture attempts (RR 2.13, 1.10 to 4.11, p = 0.03) were significantly higher in the d-TRA group. The use of d-TRA for coronary angiography and/or intervention is associated with a lower risk of RAO at the forearm and may preserve p-TRA site for reintervention in selective patients by reducing the incidence of RAO.

Prognostic factors of surgical management for heart failure patients with reduced left ventricular ejection fraction

ObjectivesThere are many available pharmaceutical and surgical management for Coronary artery disease (CAD) patients. However, coronary artery bypass grafting (CABG) is the preferred treatment modality for CAD patients with low ejection fraction (EF) in view of the more favorable outcomes. This study aimed to determine the associated factors of poor outcomes post-CABG for heart failure patients with reduced left ventricular ejection fraction who underwent on-pump and off-pump CABG. MethodsA retrospective review of CAD patients who underwent isolated on-pump CABG (ONCAB) or off-pump CABG (OPCAB) in Beijing Anzhen Hospital Affiliated with Capital Medical University from January 2013 to March 2021. Only those with confirmed reduced left ventricular ejection fraction (LVEF) ≤40% on preoperative echocardiography were included. By analyzing the clinical and surgical data, postoperative mortality and morbidity, as well as major cardiovascular and cerebrovascular adverse events (MACCE) as endpoints, certain risk factors of the postoperative complications were identified. ResultsOut of the 500 patients, 64 developed MACCE, of which 14 (13.6%) occurred in the ONCAB group and 50 (14.0%) in the OPCAB group. Univariate COX regression analysis showed that age ≥65 years, history of diabetes, and preoperative renal insufficiency were independent risk factors for postoperative primary endpoint events in CAD patients with heart failure with reduced ejection fraction (HFrEF). Following the multivariate COX regression analysis, in addition to the above three risk factors, a history of previous percutaneous coronary angiography (PCI) intervention was also a risk factor for the occurrence of the primary endpoints post-CABG. ConclusionBased on the analysis, significant predictors of post-CABG MACCE in patients with HFrEF included being older than 65 years old, having diabetes, preoperative renal insufficiency, and having previous PCI.

Factors in Predicting Short Term Mortality in ST Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Background: Percutaneous coronary angiography and intervention have been applied in the diagnosis and treatment of coronary artery disease at Gia Dinh People's Hospital since April 2009 until now with very positive results, contributing to improving the quality of diagnosis and treatment. Treating cardiovascular patients with high technology. However, there is currently no research to help evaluate performance as well as prognostic factors affecting treatment outcomes at this unit. Therefore, we conducted this study with the research question: Short-term mortality rate in patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention at Gia Dinh People's Hospital. What is the year 2022 - 2023? What factors predict short-term mortality in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Materials and methods: There were 163 patients at the Gia Dinh People's Hospital from November 2022 to September, 2023. This was a cohort study. Results: In-hospital and 30-day mortality rates after intervention were 4.29% and 4.91%, respectively. Short-term mortality prognostic factors include systolic blood pressure &lt; 100 mmHg, arrhythmia at admission, TIMI score &gt; 6, cardiogenic shock before the procedure, blood potassium concentration with mortality rate within 30 days after PCI, with p &lt; 0.05. Conclusion: In clinical practice, attention should be paid to factors predicting 30-day mortality in STEMI patients include systolic blood pressure &lt; 100 mmHg, arrhythmia at admission, TIMI score &gt; 6, cardiogenic shock before the procedure, blood potassium concentration with mortality rate within 30 days after PCI.

Bilateral Ocular Ischaemic Syndrome due to Carotid Artery and Cardiovascular Disease: A Case Report

Introduction : Ocular ischemic syndrome (OIS) is a rare but potentially blinding and fatal condition caused by carotid artery disease or other systemic condition results in ocular hypoperfusion.&#x0D; Case Illustration : A 62-year-old male with sudden bilateral vision loss, swelling, redness and pain of both eye for 7 days. There were dilated conjunctival and episcleral vessels, visual acuity of the right eye was hand movement and 0.05 for left eye, intraocular pressure (IOP) was 33 mmHg in right eye and 37 mmHgfor left eye. Anterior segment evaluation revealed rubeosis iris, mild anterior chamber reaction, and temporal angle neovascularization on gonioscopy. Both direct and consensual light reflexes were sluggish. Fundus examination showed normal optic disc, minimal hemorrhages at mid-periphery, narrowed arterioles, and minimal cotton wool spot. Macular OCT demonstrated discrete hyperreflectivity of inner retinal layers. From Macular Angiography OCT, ETDRS Central vessel density were 11.2% and 17.6% for the right eye and left eye, respectively. In both eyes, paracentesisof anterior chamber, intravitreal and intracameral injections of anti-VEGF were performed. Brain Magnetic Resonance Angiography Imaging revealed moderate stenosis of both distal carotid artery circulation. Percutaneous Coronary Angiography showed extensive stenosis in coronary artery, with low Ejection Fraction.&#x0D; Discussion : For the cardiovascular management, a pacemaker was implanted. One week after procedure, BCVA were 1/60 and 0.15, and IOPs of 17 and 18 mmHg, for the right and left eye, respectively. The patient was scheduled to have laser retinal photocoagulation.&#x0D; Conclusion : Quick clinical diagnosis, targeted workup for systemic associations, and prompt treatment might preserve life and sight in OIS.

Perirenal Fat Thickness Is Associated With Contrast-Induced Nephropathy in Type 2 Diabetic Patients Undergoing Coronary Catheterization.

Background: Deposition of adipose tissue may have a promoting role in the development of diabetic complications. This study is aimed at investigating the relationship between adipose tissue thickness and risk of contrast-induced nephropathy (CIN) in patients with Type 2 diabetes mellitus (T2DM). Methods: A total of 603 T2DM patients undergoing percutaneous coronary angiography or angioplasty with suspicious or confirmed stable coronary artery disease were enrolled in this study. The thicknesses of perirenal fat (PRF), subcutaneous fat (SCF), intraperitoneal fat (IPF), and epicardial fat (ECF) were measured by color Doppler ultrasound, respectively. The association of various adipose tissues with CIN was analyzed. Results: Seventy-seven patients (12.8%) developed CIN in this cohort. Patients who developed CIN had significantly thicker PRF (13.7 ± 4.0 mm vs. 8.9 ± 3.6 mm, p < 0.001), slightly thicker IPF (p = 0.046), and similar thicknesses of SCF (p = 0.782) and ECF (p = 0.749) compared to those who did not develop CIN. Correlation analysis showed that only PRF was positively associated with postoperation maximal serum creatinine (sCr) (r = 0.18, p = 0.012), maximal absolute change in sCr (r = 0.33, p < 0.001), and maximal percentage of change in sCr (r = 0.36, p < 0.001). In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) of PRF (0.809) for CIN was significantly higher than those of SCF (0.490), IPF (0.594), and ECF (0.512). Multivariate logistic regression analysis further confirmed that thickness of PRF, rather than other adipose tissues, was independently associated with the development of CIN after adjusted for confounding factors (odds ratio (OR) = 1.53, 95% CI: 1.38-1.71, p < 0.001). Conclusions: PRF is independently associated with the development of CIN in T2DM patients undergoing coronary catheterization.

2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Cardiac arrest is common and deadly, affecting up to 700 000 people in the United States annually. Advanced cardiac life support measures are commonly used to improve outcomes. This "2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support" summarizes the most recent published evidence for and recommendations on the use of medications, temperature management, percutaneous coronary angiography, extracorporeal cardiopulmonary resuscitation, and seizure management in this population. We discuss the lack of data in recent cardiac arrest literature that limits our ability to evaluate diversity, equity, and inclusion in this population. Last, we consider how the cardiac arrest population may make up an important pool of organ donors for those awaiting organ transplantation.

Coronary Angiographic Findings between Diabetic and nondiabetic Patients in Coronary Artery Disease: A Comparative Study

Background &amp; Objectives: Coronary artery disease (CAD) accounts for the major risk factor of mortality in diabetes. Coronary angiography is the “gold-standard” technique for diagnosing and evaluating CAD. Material and Methods: The present study was undertaken at Border Guard hospital, Dhaka between the periods of November - 2017 to December 2021. Percutaneous coronary angiography (CAG) was performed in 204 consecutive patients with suggestive of ischaemic chest pain. The population consisted of 88 cases which are diabetic and 116 cases nondiabetic Results: We observed angiographic lesion among both groups comparing site &amp; number of vessel(s) involvement and also average percentage of stenosis. The presence of coronary risk factors was not significantly different between the two populations. Total positive angiographic lesion was (61.5%) in both groups. Among the Diabetes mellitus patients positive CAG finding (69.3%). The recognized lesions were single vessel disease (SVD) 23 (26.1%), double vessel disease (DVD) 14 (15.9%), triple vessel disease (TVD) 24 (27.3%) percentage of vessel stenosis 82.63%. On the other hand, total positive angiographic lesion was 70 (53.4%) in non-diabetic group; among them single vessel disease (SVD) 30 (25.9%), double vessel disease (DVD) 15(12.9%), triple vessel disease (TVD) 17 (14.7%). No diffuse lesions was found and average vessel stenosis was 78.03%. The results of the angiographic finding suggest that diabetic patients have a higher incidence of coronary heart disease (CHD), DVD, TVD, diffuse lesion &amp; marked stenosis of coronary vessel than non-diabetic patient. Conclusion: CAD in diabetics had considerably higher percent of severe and unpredictable presentation. This increased frequency of complex lesion morphology is more difficult to treat by definitive intervention like percutaneous transluminal coronary angioplasty (PCI) &amp; coronary artery bypass graft (CABG). Diabetics have a higher risk factor profile and poor clinical outcome. Early diagnosis and appropriate management will reduce the risk of complication after the onset of disease. University Heart Journal 2023; 19(1): 5-9