Single-vessel Disease Research Articles

Global Longitudinal Strain Measured by 2D Speckle Tracking Echocardiography in Stable Angina Patients and Their Angiographic Correlation

Introduction & Objective: Myocardial strain assessed by Speckle Tracking Echocardiography (STE) quantifies myocardial deformation which appears earlier than wall motion abnormality. Thus Global Longitudinal Strain (GLS) assess myocardial function in early stage of ischemic evolution. The aim of the study was to estimate GLS in coronary angiography undergoing intermediate to high risk stable angina patients which could correlate GLS with significant Coronary Artery Disease (CAD), determine cut-off value for identifying significant CAD and find sensitivity and specificity for the GLS cut-off value. Methods: This was a cross-sectional study which included stable angina patients with normal left ventricular ejection fraction who were otherwise indicated to undergo coronary angiography. All the patients underwent STE and their GLS value was calculated. The coronary artery angiography findings were then correlated with GLS using appropriate statistics. Results: A total of 89 patients were included. There was a strong negative correlation (r = -0.824) between GLS value and presence of significant CAD. The mean values of GLS for single vessel disease, double vessel disease and triple vessel disease were -15.94 ± 7.30, -15.28 ± 0.58 and -11.59 ± 1.35 (P <0.001) respectively. The GLS cut-off value ≤ -18.5 identified significant CAD and the sensitivity, specificity and area under curve for this cut-off value was 96.8%, 85.2% and 0.937 respectively (P<0.001). Conclusion: Global longitudinal strain is a sensitive, specific and excellently accurate modality that had a strong negative correlation with presence and severity of significant CAD.

Incremental value of myocardial work analysis for detection of coronary artery disease during dipyridamole stress echocardiography

Abstract Funding Acknowledgements Type of funding sources: None. Background Dipyridamole stress-echocardiography (DipSE) relies on operator’s expertise and might have suboptimal diagnostic accuracy in identifying patients (pts) with single-vessel coronary artery disease (CAD). 2D strain, and, recently, myocardial work (MW) analysis, provide a more accurate evaluation of myocardial function, being able to detect subtle regional abnormalities. Purpose Aim of our study was to investigate whether MW analysis could have an additive role, when implemented to DipSE, in CAD detection. Methods We retrospectively enrolled 50 pts (20 M) who underwent DipSE followed, within one month, by coronary CT (CCT), in the absence of stress-induced WM abnormalities, or by invasive coronary angiography (ICA), when new WM abnormalities occurred. According to the presence of obstructive CAD (confirmed by ICA in any case), the population was subdivided into 2 groups: group 1 (with obstructive CAD: 34 pts) and group 2 (without obstructive CAD: 16 pts). After matching DipSE and CCT/ICA results, we further subdivided the population into three subgroups: 1 (true positives: 34 pts), 2A (false positives: 9 pts) and 2B (true negatives: 7 pts); no patients had a false negative DipSE result. Global longitudinal strain (GLS), work index (GWI), constructive work (GCW), waste work (GWW) and work efficiency (GWE) were calculated, at baseline, low and peak dose. Results In group 1, GLS increased at low and decreased at peak dose (p 0.015), while, in group 2, increased, mostly from low to peak dose (p< 0.001), Fig. 1. GWI and GCW, at low dose, decreased in group 1 (p 0.035 and p 0.009) whereas increased in group 2 (p 0.042 and p ns). GWW increased, at peak dose, in group 1 (p 0.003), whereas decreased in group 2 (p 0.047). GWE decreased, at peak dose, in group 1 (p 0.025), whereas increased in group 2 (p 0.001). When evaluating the subgroups (Fig. 1, right panels), we found that, in subgroup 2A, GLS increased at low and decreased at peak dose (p 0.015), similarly to subgroup 1 (at low dose p 0.011) and differently from subgroup 2B (from baseline to peak dose p 0.003). GWE, in subgroup 2A, increased at peak dose (p 0.023), differently from subgroup 1 (p 0.001) and similarly to subgroup 2B (at low dose: p 0.026; at peak dose: p 0.029). ROC analysis, for obstructive CAD, showed that GLS had a lower AUC (0.653) than GWW (0.735) and GWE (0.845), whereas GWI and GCW had, an AUC of 0.606 and 0.591, respectively (Fig. 2). A ≥ 0.5% GLS change (from low to peak dose) gained a sensitivity of 58%, a specificity of 67%, a positive predictive value (PPV) of 66% and a negative predictive value (NPV) of 64%. Conversely, a ≥ −1.5% GWE change (from low to peak dose) provided a sensitivity of 73%, a specificity of 84%, a PPV of 86% and NPV of 79%. Net reclassification improvement (NRI) for GWE was 0.049 (p 0.005). Conclusion MW analysis beyond GLS shows an additive role in the detection of CAD, thus improving diagnostic performance of DipSE.

Angiographic Finding in Acute Coronary Syndrome in Female Patient’s Diabetic vs Non-Diabetic

Background: From January 2018 to July 2018, a study was conducted at Hayatabad Medical Complex's Department of Cardiology to analyze the angiographic results of female patients admitted for acute coronary syndrome (ACS). The study group consisted of 75 female patients with ACS; thirty patients were diabetic, while the remaining forty-five were non-diabetic. Results from angiography revealed that single vessel disease (36.67%) was the most common finding in non-diabetic patients, followed by two vessel disease (31.11%). The study found that disease severity in diabetic patients varied more, with the majority (43.33%) having two vessel disease. Single vessel disease (33.33%) and three vessel disease (23.33%) were also frequently observed. Conversely, non-diabetic patients displayed more normal coronaries (44.44%) while diabetic patients tended to have more diseased vessels (66.67%). Ultimately, the study determined that female diabetics with ACS exhibit a wider range of complex diseases compared to their non-diabetic counterparts. Objectives: From January 2018 to July 2018, Department of Cardiology at Hayatabad Medical Complex in Peshawar received admissions for acute coronary syndrome (ACS) in both diabetic and non-diabetic female patients. Our present study aims to compare the findings of their angiograms. Methodology: The present study had 75 female patients admitted to Hayatabad Medical Complex's Cardiology Department between January and July 2018 for ACS. Medical records were reviewed for age, medical history, and angiography findings. A comparison of non-diabetic and diabetic patients showed 45 and 30 patients, respectively. The severity of the ACS was determined by the number of vessel involvement and coronary artery status in the angiography report. Results: Single vessel disease was identified as the most common finding in 36.67% of non-diabetic patients, while two vessel disease was noted in 31.11%. However, in diabetic patients, the most frequent discovery was two vessel disease with 43.33%, followed by single vessel disease in 33.33% and three vessel disease in 23.33%. In terms of coronary artery status, more non-diabetic patients had normal coronaries (44.44%) in contrast to diabetic patients who showed more diseased vessels with a percentage of 66.67%. Conclusion: The study revealed a greater range and complexity of illness severity among female ACS patients with diabetes than those without. This indicates that those with diabetes are more susceptible to severe ACS forms, underscoring the importance of their careful monitoring to minimize the chances of cardiovascular complications. Keywords: ACS, Angiography, Diabetic, Non-Diabetic, Coronary Artery.

CAUSES OF AN UNFRIENDLY CLINICAL OUTCOME OF MYOCARDIAL INFARCTION AGGRAVATED BY CARDIOGENIC SHOCK: A SINGLE-CENTER RETROSPECTIVE STUDY

Summary. Aim. Search for risk factors of adverse clinical outcome of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).
 Materials and methods. 1,292 consecutive patients with AMI treated by emergent percutaneous coronary intervention (PCI) in the reperfusion center of Zaitsev V.T. Institute for General and Emergency Surgery NAMS of Ukraine were selected. 54 out of 1292 patients (4.2%) matched the Society for Cardiovascular Angiography and Interventions (SCAI) criteria of CS stage C and higher either on admission or during hospitalization.
 Results. The overall hospital mortality in patients with CS due to AMI in our series was 59.3%. Univariant analysis revealed that the age of 65 and higher, left ventricular ejection fraction <40%, a single-vessel coronary lesion, absence of concomitant chronic total occlusion (CTO), reperfusion deterioration and cardiac arrest were the only risk factors for hospital death in CS patients. The risk of CS progression was independently associated with anemic syndrome (Hb < 118 g/l), chronic total occlusion, and multivessel coronary disease. In a multivariant logistic regression the preexisting LV EF
 <40%, single-vessel disease and absence of CTO were found as the independent predictors of hospital mortality in СS.
 Conclusions. СS in patients with AMI still be a significant challenge even after successful PCI, associated with high in-hospital mortality (59.3%). There is an unmet need for development and implementation of an adjusted registry-based national protocol for CS management in order to improve patient survival.

Comparison of Angiographic Findings in Diabetic and Non-Diabetic Female patients presenting with Acute Coronary Syndrome at a Tertiary Cardiac Care Center in Karachi, Pakistan

Objective: -To evaluate the angiographic differences in female patients and to compare the frequency of different angiographic findings in diabetic and non-diabetic female cases with acute coronary syndrome. Place and Duration of Study: Department of Adult Cardiology, Tabba Heart Institute Karachi, Pakistan from 1st February 2018 to 31st August 2018 Study design: Cross-sectional study Methodology: Two hundred patients presenting with acute coronary syndrome undergoing angiography with diabetes mellitus and non-diabetes mellitus were enrolled. Demographic profile of the cases was recorded Angiography was performed by experienced cardiologist for all patients. Study outcome, number of vessels involved, type of vessels, was recorded for all patients. All the collected information was recorded using pre-designed structural questionnaire. Results: 67% were diabetic and 23% were non-diabetic. In diabetic group single vessel disease was observed in 29 (23%), 2 vessel disease in 37 (29.4%) and 3 vessel disease in 49 (38.9%) while in non-diabetic group single vessel disease, 2 vessel disease and 3 vessel disease was observed in 24 (32.4%), 19 (25.37%) and 19 (25.7%) respectively (P=0.092). Three vessel disease involving LAD+ Circumflex+ RCA is 49 [38.88%] and 19 [25.67%] in diabetic and non-diabetic group respectively. Three-vessel disease was more prevalent in diabetics but it was not statistically significant (p=0.092). Conclusion: Three vessel diseases is most frequently present as angiographic finding in female patients presenting with acute coronary syndrome. Keywords: Acute coronary syndrome (ACS), Diabetes mellitus (DM), Unstable angina, ST-elevated myocardial infarction

Pre-hospital delay, clinical characteristics, angiographic findings, and in-hospital mortality in young and middle-aged adults with acute coronary syndrome: a single-centre registry analysis.

There are several differences between younger and older adults with acute coronary syndrome (ACS). However, few studies have evaluated these differences. We analysed the pre-hospital time interval [symptom onset to first medical contact (FMC)], clinical characteristics, angiographic findings, and in-hospital mortality in patients aged ≤50 (group A) and 51-65 (group B) years hospitalised for ACS. We retrospectively collected data from 2010 consecutive patients hospitalised with ACS between 1 October 2018 and 31 October 2021 from a single-centre ACS registry. Groups A and B included 182 and 498 patients, respectively. ST-segment elevation myocardial infarction (STEMI) was more common in group A than group B (62.6 and 45.6%, respectively; P < 0.001). The median time from symptom onset to FMC in STEMI patients did not significantly differ between groups A and B [74 (40-198) and 96 (40-249) min, respectively; P = 0.369]. There was no difference in the rate of sub-acute STEMI (symptom onset to FMC > 24 h) between groups A and B (10.4% and 9.0%, respectively; P = 0.579). Among patients with non-ST elevation acute coronary syndrome (NSTE-ACS), 41.8 and 50.2% of those in groups A and B, respectively, presented to the hospital within 24 h of symptom onset (P = 0.219). The prevalence of previous myocardial infarction was 19.2% in group A and 19.5% in group B (P = 1.00). Hypertension, diabetes, and peripheral arterial disease were more common in group B than group A. Active smoking was more common in group A than group B (67 and 54.2%, respectively; P = 0.021). Single-vessel disease was present in 52.2 and 37.1% of participants in groups A and B, respectively (P = 0.002). Proximal left anterior descending artery was more commonly the culprit lesion in group A compared with group B, irrespective of the ACS type (STEMI, 37.7 and 24.2%, respectively; P = 0.009; NSTE-ACS, 29.4 and 21%, respectively; P = 0.140). The hospital mortality rate for STEMI patients was 1.8 and 4.4% in groups A and B, respectively (P = 0.210), while for NSTE-ACS patients it was 2.9 and 2.6% in groups A and B, respectively (P = 0.873). No significant differences in pre-hospital delay were found between young (≤50 years) and middle-aged (51-65 years) patients with ACS. Although clinical characteristics and angiographic findings differ between young and middle-aged patients with ACS, the in-hospital mortality rate did not differ between the groups and was low for both of them.

Association of Preoperative Hba1c Level with Incidence of New-Onset Atrial Fibrillation during Early Postoperative Period after On-Pump Coronary Artery Bypass Grafting Surgery in Diabetic Patients

Introduction: Atrial fibrillation (AF) is a common complication following coronary artery bypass grafting (CABG) surgery, particularly in diabetic patients. Elevated preoperative HbA1c levels have been suggested as a potential risk factor for postoperative AF; however, the association remains unclear. This study aimed to investigate the association between preoperative HbA1c levels and the incidence of new-onset atrial fibrillation during the early postoperative period in diabetic patients undergoing on-pump CABG surgery in Bangladesh. Methods: This observational cross-sectional study was conducted at the Department of Cardiac Surgery, National Institute of Cardiovascular Disease, Dhaka, Bangladesh. A total of 60 diabetic patients undergoing on-pump CABG were included and divided into two groups: Group-1 (HbA1c &lt;7%, n=30) and Group-2 (HbA1c ≥7%, n=30). Data were collected using a preformed data collection sheet, and statistical analysis was performed using the chi-square test, Fisher's test, and student's t-test. Result: In this study, Group-1 (HbA1c &lt;7%) consisted of 30 patients, while Group-2 (HbA1c ≥7%) also comprised 30 patients. The mean age of Group-1 was 58.50±6.80 years, and that of Group-2 was 50.53±6.01 years (p &lt; 0.001). The distribution of preoperative variables such as single, double, and triple vessel disease, hypertension, history of antiarrhythmic drug use, and NYHA class III and IV showed no significant differences between the groups (p &gt; 0.05). However, preoperative HbA1c levels were significantly different between the two groups (6.11±0.44 in Group-1 vs. 7.98±0.55 in Group-2, p &lt; 0.001). The incidence of new-onset atrial fibrillation during the early postoperative period was significantly higher in Group-2 (63.33%) than in Group-1 (30.00%, p &lt; 0.05). A significant association was also observed between postoperative atrial fibrillation and hypertension (p &lt; 0.05). Patients in Group-2 experienced a higher rate of postoperative complications, .......

Multislice CT coronary angiography and coronary artery calcium scoring, correlation with Heart Score

BackgroundCoronary atherosclerosis is the number one leading cause of death. According to estimates, if all primary cardiovascular diseases (CVDs) had been eradicated, life expectancy could increase by nearly seven years. Long asymptomatic latent phases of coronary heart disease allow for early preventive measures. Egypt has a high prevalence of premature Coronary Artery Disease (CAD).Aim of studyWe aimed to evaluate the correlation between the cardiovascular risk assessed by the Systematic COronary Risk Evaluation (HeartScore) and Coronary Artery Calcium Score (CACS) versus the actual extent of atherosclerotic CAD affection among a sample of Egyptian patients assessed by Multislice Computed Tomography (MSCT) due to chest pain complaints.MethodsAn observational cross section study included one hundred studied cases: aged 40 to 69 years old, of which 63% were males, 63% were hypertensive, 39% were diabetic, and 28% were smokers. Those patients presented with symptoms suggestive of coronary artery disease (chest pain). All studied cases had been subjected to history and examination, electrocardiograph (ECG), kidney functions, lipid profile, SCORE calculation, and coronary MSCT scan.ResultsOur observational study found a moderately significant positive relationship between the HeartScore and CACS and CAD; having a higher score carries a higher probability of having CAD. Having a very low score is a good negative test for exclusion. Also, there is a weak relationship between HeartScore, CACS, and the number of diseased coronaries, i.e. these cannot differentiate single vessel disease (SVD) from Multivessel Disease (MVD). In addition, both scores could not determine Obstructive Coronary Artery Disease (OCAD) and Nonobstructive Coronary Artery Disease (Non-OCAD).ConclusionsFrom the clinical point of view, our research suggests that HeartScore and CACS have moderate value in predicting CAD.

It is not too late for ... percutaneous angiography in a 90-plus population

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Elderly people represent a vulnerable but increasing population presenting to percutaneous coronary intervention (PCI). The benefit of revascularization in acute coronary syndromes (ACS) is well-stablished. However, the benefit in elderly patients has been questioned, considering the patient’s expected survival, functional and cognitive status, comorbidities, procedure’s risk and need for extended anti-thrombotic therapy. Purpose To evaluate the effect of PCI on the prognosis of a group of very old patients with acute coronary syndrome (ACS). Methods We retrospectively analyzed all consecutive very old patients (≥90-year-old) admitted with ACS submitted to coronarography (CA) in one tertiary center, from January 2008 to December 2021. Clinical features were collected, including major adverse cardiac events (MACE), a defined composite endpoint of all-cause death, ischemic stroke, ACS, or hospitalization for acute heart failure, which were compared according if PCI was performed or not. Q-square, Cox regression and Log-rank tests were applied. Results A total of 79 patients were enrolled; 43 of them underwent PCI. Groups were comparable in basal characteristics, with similar median age at the event (92 years old, interquartile range IQR: 3), see picture 1. Most patients with ST-elevation (STE) ACS (n=45) had PCI (70% vs. 41%, p= 0,01), while in non ST-elevation (NSTE) ACS and unstable angina there was higher proportion of non-PCI (30% vs. 58%, p= 0,01). Individuals submitted to PCI were more likely to have single or double lesion vessel (76% vs 27%, p&amp;lt;001), while non-PCI patients presented more complex disease (23% vs 25%, p=0,5). Among the PCI-patients, the majority was singly revascularized (86%) and submitted to stent implantation (83%). Regarding in-hospital mortality, there was no difference between groups: 21% in the PCI group versus 33% in the non-PCI control group (p=0.2). During median follow-up time of 6 months (IQR: 27), mortality was similar in both groups (79% vs 67%; p=0.1). Nevertheless, overall MACE-free survival was significantly longer in PCI group than in the no-PCI group, and PCI treated patients had a risk of MACE 52% lower than the patients assigned to medical therapy (hazard ratio 0.508, p=0.007); see picture 2. Conclusion Very old patients presenting with ACS treated with either PCI presented longer MACE-free survival. These finding suggest that very old patients with ACS and single vessel disease may benefit systematically from PCI with stent. Efforts should be made to optimize care in this under-represented population in the clinical trials.

CORONARY ARTERY BYPASS SURGERY IN YOUNG ADULT A INSTITUTIONAL RETROSPECTIVE STUDY

Objective: To study the overall causes, perioperative mortality, post operative complications, prognosis, outcome and follow up in a young adult present with coronary artery disease under going coronary artery bypass in our institute. Methods: Asum of 56 patient who are 40 years and less then 40 years who underwent coronary artery bypass surgery between January 2017 to December 2022 who's clinical case history, coronary angiography, pre operative and post operative echo cardiography, operative notes, post operative notes, outpatient follow up are collected from our computer stored data and from medical record department in our college and from Tamilnadu chief minister comprehensive health insurance scheme institutional Web site data base Results: Out of 56 patient,8 Female(14.3%) and 48 Male(85.7%),mean age 37.1 years (range 32 – 40 years),Diabetic 39 Patient (62.5%),Hypertensive 21 patient (37.5%) 7 / 8 women(87.5%) diabetic ,3/8 women both diabetic and hypertensive. Out of 48 male 47(97.9%) chronic smoker, 45 (93.8%) chronic alcoholic,44 (91.6%) both alcoholic and smoke , no women in this study neither alcoholic or smoker, 3patient (5.35%) hyperlipidaemia, 2 patient (3.57%) hypothyroidism all 2/8 (25%) are female,2 patient on haemodialysis for kidney disease, 1patient with bilateral renal artery stenosis, 1 patient with right innominate, right subclavian, bilateral carotid stenosis. Left ventricular function was impaired with ejection fraction average 46% (range 30% - 55%). 1 patient with ventricular septal rupture.2 patient with post coronary stent, The indication for surgery was triple vessel disease in 30 patient(53.57%) ,double vessel disease in 20 patient(35.7%),single vessel disease in 1 patient, single vessel disease with ventricular septal rupture in 1 patient, left main coronary artery stenosis in 4 patient(7%). Surgical procedure Off pump coronary artery bypass surgery in 51 patient(91%), On pump beating heart coronary artery bypass surgery in 2 patient (3.57%),On pump arrested heart coronary artery bypass surgery in 3 patient(5.35%). A total of 132 grafts were constructed(mean 2.4 grafts per patient),35 (27%) of them being arterial only left internal mammary artery harvested and other grafts were great saphenous vein. Post operative average ventilation time18hrs (range 18hrs to 24hrs), There were 5(8.9%)hospital death and 5(8.9%) late death in follow up, total 10 (17.8%) death till now. Conclusion: Most common cause for young coronary artery disease from our clinical history is found to be early onset diabetic mellitus and from our personal history chronic smoking and chronic alcoholism, intra operative mortality and morbidity is high in patient present with severe left ventricular dysfunction, coronary artery diseases induced complication and additional comorbidity, however most of patient recovered from post operative cardiovascular lethal or morbid event and on regular clinical follow up

Acute Coronary Syndrome in Young (≤45 Years) Patients: An Observational Study

Background: Acute coronary syndrome (ACS) is witnessing a demographic transition with increasing prevalence among younger individuals (≤45 years). Hence, this study was designed to evaluate the clinical features, risk factors, and angiographic profile of young (aged ≤ 45 years) patients with ACS and to compare it with the older (aged &gt;45 years) patients with ACS. Materials and Methods: An observational study was conducted at a tertiary care center in India from July 2020 to December 2021. A total of 157 patients were enrolled, among which 90 patients were included in cases (group-I). The inclusion criteria were patients presenting with ACS aged between 18 and 45 years. There were two control groups, including 34 patients with ACS (aged &gt;45 years) in Group II and 33 healthy volunteers in Group III (aged 18–45 years). Baseline demographic details, risk factors, and angiographic profile of patients with ACS in each group were recorded and compared. Results: Mean age of Group I was 39.79 ± 5.15 years and of Group II was 59.74 ± 8.21 years. Smoking (P = 0.027) and family history of coronary artery disease (P = 0.022) were the significant risk factors of ACS in Group I. Compared to non-ST elevation myocardial infarction (16.7%), ST-elevation myocardial infarction (83.3%) was predominant among younger patients with ACS. Single-vessel disease was prevalent among younger patients (62.2%) as compared to older patients with ACS (41.20%). Conclusion: Younger patients with ACS exhibited a distinct clinical and angiographic profile compared to older patients with ACS.

Myocardial Infarction in Patients with and without COVID-19: Comparisons of Characteristics, Clinical Courses, and Outcomes.

COVID-19 has rapidly become a global health emergency. This infection can cause damage to various organs. Injury to myocardial cells is one of the salient manifestations of COVID-19. The clinical course and outcome of acute coronary syndrome (ACS) are influenced by various factors, including comorbidities and concomitant diseases. One of these acute concomitant diseases is COVID-19, which can affect the clinical course and outcome of acute myocardial infarction (MI). The present cross-sectional study compared the clinical course and outcome of MI and some of its practical factors between patients with and without COVID-19. The study population consisted of 180 patients (129 males and 51 females) diagnosed with acute MI. Eighty patients had COVID-19 infection concurrently. The mean age of the patients was 65.62 years. The frequencies of non-ST-elevation MI (vs ST-elevation MI), lower ejection fractions (<30), and arrhythmias were significantly higher in the COVID-19 group than in the non-COVID-19 group (P=0.006, 0.003, and P<0.001, respectively). The single-vessel disease was the most frequent angiographic result in the COVID-19 group, while the double-vessel disease was the most frequent angiographic result in the non-COVID-19 group (P<0.001). It appears that patients with ACS who are co-infected with COVID-19 infection need essential care.

Association of Waist and Hip Ratio with the Angiographicc Severity of Coronary Artery Disease in Patients with Non ST Segment Elevation Myocardial Infarction

Background: Coronary artery disease and obesity cardiomyopathy, and cardiac autonomic neuropathy are the most prevalent types of cardiac involvement in the comorbid. Obesity has a two- to fourfold greater risk of developing coronary artery disease. Stroke and other cerebrovascular occurrences fare poorly for those with obesity and diabetes. Hospital, autopsy, epidemiological, longitudinal research, and other studies have all demonstrated the increasing prevalence of cardiomyopathy in diabetes and obese individuals Objective: the objective of the study is to association of waist and hip ratio with the angiographic severity of coronary artery disease in patients with non-ST segment elevation myocardial infarction Study Design: Cross sectional observational study Study Setting: This study was conducted in the department of Interventional Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi from Ist August 2022 to 31st January 2023. Methodology: Total 120 subjects were enrolled in the study and divided in to two groups. Group I consisted of 60 patients with normal WHR, and group II consisted of 60 patients with elevated WHR. The history and anthropometric measurements were noted using a pre-designed structured form, including demographic data and a profile of potential risk factors. Three universal criteria for diagnosing myocardial infarction were used to confirm the presence of non-ST segment elevation myocardial infarction. Each participant's signed permission was obtained before any data was collected. The patient's waist and hip circumferences were measured the day before the CAG. At least two cardiologists engaged per patient's therapy or the clinical context while evaluating the angiogram results. Visual estimation (in at least two orthogonal views) was used to estimate the vessel and Gensini scores to determine the degree of coronary artery disease on angiograms. The statistical analysis was done by using SPSS version 20. Results: Patients in Group II had a considerably higher mean body mass index and anthropometric status than those in Group I. The average WHR of the participants in the study is listed in order of increasing vascular involvement. For those with normal angiogram results, the average WHR was 0.98. There was a statistically significant difference (p&lt;0.01) in the mean WHRs of those with single-vessel disease and the value of mean is gradually increased in scoring 1, 2 and 3. The WHR positively correlated with the severity of CAD as measured by vessel score (r=0.45). In addition, a positive connection (r=0.63) between WHR and CAD severity, as measured by the Gensini score. Multivariate logistic regression analysis of odds ratio (OR) for subject characteristics likely to cause coronary artery disease severity. Practical implication: In addition, there is only one local study, which provides scant information, and worldwide data is scant and conflicting about the relationship of the ratio of waist to hip with severe coronary artery disease (CAD). The incidence of obesity and coronary artery disease in Pakistan is much higher than in Western countries; thus, this study will offer more information regarding the relationship based on local data. Conclusion: The current study found that in individuals with non-ST-segment elevation myocardial infarction, increasing WHR was substantially correlated with the angiographic severity of coronary artery disease Keyword: WHR, BMI, Waist circumference, Cardiovascular disease

Cardiovascular Risk Factors, Angiographical Features and Short-Term Prognosis of Acute Coronary Syndrome in People Living with Human Immunodeficiency Virus: Results of a Retrospective Observational Multicentric Romanian Study.

People living with human immunodeficiency virus have increased cardiovascular risk due to a higher prevalence of traditional and particular risk factors such as chronic inflammation, immune dysregulation, endothelial dysfunction, coagulation abnormalities and antiretroviral therapy. In developed countries, coronary artery disease has become the most frequent cardiovascular disease and an important cause of mortality in these patients. The symptomatology of an acute coronary syndrome can be atypical, and the prevalence of each type of acute coronary syndrome is reported differently. Regarding coronary artery disease severity in people living with HIV, the literature data indicates that the presence of single-vessel disease is akin to that of HIV-negative patients, and their short-term prognosis is unclear. This study aims to assess the clinical characteristics, biological parameters, angiographical features and short-term prognosis of acute coronary syndrome in a cohort of Romanian people living with human immunodeficiency virus.

Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis.

The primary cause of death among maintenance dialysis patients is coronary artery disease (CAD). However, the best treatment plan has not yet been identified. The relevant articles were retrieved from various online databases and references from their inception to October 12, 2022. The studies that compared revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] with medical treatment (MT) among maintenance dialysis patients with CAD were selected. The outcomes evaluated were long-term (with a follow-up of at least 1 year) all-cause mortality, long-term cardiac mortality, and the incidence rate of bleeding events. Bleeding events are defined according to TIMI hemorrhage criteria: (1) major hemorrhage, intracranial hemorrhage or clinically visible hemorrhage (including imaging diagnosis) with decrease of hemoglobin concentration ≥5 g/dl; (2) minor hemorrhage, clinically visible bleeding (including imaging diagnosis) with a drop in hemoglobin of 3-5 g/dl; (3) minimal hemorrhage, clinically visible bleeding with hemoglobin drop <3 g/dl. In addition, revascularization strategy, CAD type, and the number of diseased vessels were considered in subgroup analyses. A total of eight studies with 1,685 patients were selected for this meta-analysis. The current findings suggested that revascularization was associated with low long-term all-cause mortality and long-term cardiac mortality but a similar incidence rate of bleeding events compared to MT. However, subgroup analyses indicated that PCI is linked to decreased long-term all-cause mortality compared to MT but CABG did not significantly differ from MT in terms of long-term all-cause mortality. Revascularization also showed lower long-term all-cause mortality compared to MT among patients with stable CAD, single-vessel disease, and multivessel disease but did not reduce long-term all-cause mortality among patients with ACS. Long-term all-cause mortality and long-term cardiac mortality were reduced by revascularization in comparison to MT alone in patients undergoing dialysis. Larger randomized studies are needed to confirm the conclusion of this meta-analysis.

Immediate results of percutaneous transluminal angioplasty in patients above 70 years

Background: Even in older patients, percutaneous transluminal coronary angioplasty (PTCA) is becoming a more widely acknowledged technique for revascularization. Because to its less intrusive nature, PTCA is a desirable option to coronary bypass surgery in this age category due to the increased frequency of postoperative mortality and treatment problems in older patients. Objective: Analyze the immediate and ongoing therapeutic efficacy of PTCA in individuals above 70 years. Methods: In the Hayatabad Medical Complex hospital in Peshawar, 6830 patients had PCI between April 2021 and August 2022. Throughout the trial period, interventions were performed on 102 male patients who were above 70 years. Results: Among the 102 patients, Thirty-two patients (31.37% of the total) had left ventricular ejection fraction (LVEF) lower than 40%. One hundred percent of patients with single vessel disease (SVD), 94 % and 72 % of participants with double vessel disease and triple vessel disease (TVD), respectively had successful procedures. The rate of major adverse cardiac event (MACE) in hospitals was 9/102 (8.82%). The 1-month MACE incidence was 10.78% (n=11) while the one-year MACE incidence was 17.64% (n=18), correspondingly.

Effect of Coronary Artery Dominance In-terms of Presentation and In-hospital Outcomes of patients undergoing Primary PCI for Culprit Proximal Left Anterior Descending Artery

Objectives: Objective of this study was to assess the difference in terms of presentation and in-hospital course between patients with right vs. left dominant arterial circulation undergoing “primary percutaneous coronary intervention (PCI)” for culprit proximal left anterior descending artery (LAD). Methodology: We included consecutive adult (≥18 years) patients diagnosed with STE-ACS undergoing primary PCI for culprit proximal LAD. Patients were categorized into right vs. left dominant circulation on left heart catheterization. Demographic, clinical characteristics, presentation, and hospital course were compared between the matched (propensity matched) and unmatched cohort of patients with right vs. left dominance. Results: We included 775 patients, out of which 81.3% (630) were males and mean age was 54.59 ± 11.3 years. On coronary angiogram left dominance was observed in 14.3% (111). Single vessel disease was higher with left compared to right dominant system, 53.2% vs. 43.5%, respectively. The rate of slow flow/no-reflow (15.4% vs. 7.2%; p=0.0.230), heart failure (9.3% vs. 6.3%; p=0.299), and in-hospital mortality (5.1% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively. In the matched cohorts, the frequency of slow flow/no-reflow (15.3% vs. 7.2%; p=0.056), heart failure (6.3% vs. 6.3%; p&gt;0.999), and mortality (5.4% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively. Conclusion: No significant increase in complications and outcomes is witnessed among patients with left dominant arterial circulation undergoing primary PCI for culprit proximal LAD. However, careful handling of left main during intervention is warranted due lack of support from right system.

Obstructive Coronary Artery Disease in Patients Undergoing Rheumatic Valvular Heart Surgery

Objectives: The presence of concomitant obstructive coronary artery disease (CAD) in patients with valvular heart disease (VHD) carries significant prognostic implications. Therefore, the objective of this study was to determine the frequency and severity of obstructive CAD in patients undergoing valvular heart surgery for rheumatic heart disease (RHD) at a tertiary care hospital in Karachi, Pakistan. Methodology: This descriptive study included patients of either gender, between 40 to 70 years of age, diagnosed with RHD on transthoracic echocardiography, and undergone valvular heart surgery. As a routine, pre-operative diagnostic coronary angiography was performed and the presence and severity of obstructive CAD were recorded. Results: Among 126 patients, 73% (92) were male, and the mean age was 48.3 ± 7.1 years. Smoking was the most common risk factor with a frequency of 22.2%, followed by hypertension (7.1%) and diabetes (4.8%). Obstructive CAD was observed in 24.6% with 19.4% single-vessel disease, 16.1% with two-vessel disease, and 64.5% with three-vessel disease. The presence of obstructive CAD was found to be positively associated with older age (p=0.040) and type of RHD (p=0.048). Conclusion: The obstructive concomitant CAD is prevalent in around 1/4th of patients, most of them with multi-vessel diseases, undergoing valvular heart surgery for rheumatic heart disease. It has been further observed that older age and the type of RHD are positively associated with the incidence of concomitant CAD in these patients.

Assessment of the Severity of CAD Regarding Number of Vessels Involved

Background: Coronary artery disease (CAD) is characterized by atherosclerotic plaque accumulation in the epicardial arteries. The dynamic nature of the CAD process results in various clinical presentations. Red blood cell distribution width (RDW) is a practical, widely available marker for assessing the severity of coronary artery disease and helps in the risk stratification of patients with CAD. This study aimed to analyze the severity of CAD regarding the number of vessels involved. Material Methods: This descriptive cross-sectional study included 124 purposively selected patients who underwent elective CAG in the Department of Cardiology, Chittagong Medical College Hospital, Chattogram, from January 2020 to June 2021. SPSS 23.0 software was used for processing and analysis at the end of the data collection period. Results: The age of the patients ranged from 32-75 years with a mean (±SD) age of 53.4 (±9.9) years. The majority of the patients (83.1%) were male with a male-to-female ratio of 4.9:1. On coronary angiography, the majority of the patients (51/124, 41.1%) had triple vessel disease, followed by double vessel disease in 23 (28.5%) patients, single-vessel disease in 31 (25.0%). In 19 (15.4%) patients no significant lesion was observed in any of the vessels. Gensini score ranged between 1 and 176 in the study with a median score of 56.77. The majority of the patients (69.4%) in the present study had a Gensini score ≥30 indicating severe stenosis. A positive correlation between RDW and coronary artery disease severity in terms of Gensini score (r=0.393). With the increase of RDW, the Gensini score increases. It was found statistically significant (p=&lt;0.001) by Pearson’s correlation test. There was a positive correlation between RDW and CAD severity regarding the number of vessels involved (rho =0.5). With the increase of RDW, the number of involved vessels increases. It was found statistically significant (p=&lt;0.001) by Spearman’s correlation test. The Median (IQR) value of RDW was 13.5 (13.0-14.0) in patients with mild stenosis compared to 14.5 (13.9-15.0) in patients with severe stenosis. This difference was statistically significant (p&lt;0.001). The median (IQR) value of RDW was the lowest in patients without any significant stenosis in any of the coronary arteries [13.1% (12.7%-13.5%)] and was the highest in patients with triple vessel diseases [14.5% (14.1%-15.0%)]. Conclusion: This study demonstrated that RDW level was an independent predictor for CAD and the severity of coronary stenosis. So, it can be concluded that RDW is an inexpensive routine laboratory test that might help identify high-risk patients before planning for a more invasive treatment strategy.

Characteristics and treatment analysis of young acute coronary syndrome patients in a tertiary care hospital: A cross-sectional retrospective study.

The prevalence of acute coronary syndrome (ACS) has been rising in the younger population worldwide. To fully comprehend the effects of the condition, it is crucial to examine the evolving characteristics and treatment options. The purpose of this study is to evaluate the characteristics and treatment analysis for young ACS patients in a tertiary care setting. This cross-sectional, retrospective, single-center study included a random sample of patients who had been hospitalized for ACS over the period of a year. We collected and analyzed data on risk factors, diagnoses, angiographic patterns, and potential treatments. The study involved 198 young ACS patients in total. The majority of patients (57%) had no risk factors, and the majority of them (44%) had ST-elevation myocardial infarction (STEMI) as their diagnosis. The most common type (48%) was single-vessel disease (SVD). Statins and antiplatelet medications made up the majority of the patients' nonsurgical treatments (88% and 87%, respectively). A statistically significant difference exists between young and older ACS patients with gender (p < 0.01). However, it is not clinically relevant. Men were the majority of young ACS patients, and STEMI, SVD were more prevalent. The majority of young ACS patients had no significant risk factors. To determine the risk factors of young ACS patients, a more thorough case-control study is critically needed.