Angiograhic profile and in-hospital outcome of young patients presenting with ST Elevation Myocardial Infarction (STEMI) in tertiary cardiac hospital

Objective: To assess the angiographic profile and in hospital outcomes of primary percutaneous coronary intervention among young patients presenting with acute ST Elevation Myocardial Infarction and underwent primary PCI. Methods: The retrospective observational study was conducted at Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, from july 2020 to June 2021, and included acute ST-Elevation Myocardial Infarction patients underwent primary percutaneous coronary intervention (PCI). Data was collected on demographic, angiographic, and in-hospital outcomes. Patients <45 years were considered young. Data was analysed using SPSS 21. Results: Total 104 patients met the inclusion criteria. Mean age of presentation was 40.16 ± 4.42 years. Over three-fourth of the patients were male 80 (76.9%). Smoking was the most prevalent risk factor with 61 (58.6%) patients followed by hypertension 35 (33.6%) and dyslipidemia 23 (22.1%). Single Vessel Disease (SVD) was the most common finding seen in 62 patients (59.6%) and Left Anterior Descending Artery (LAD) was the most commonly involved artery seen in approximately three fourth patients 80 (76.9%) followed by RCA 61 (58.6%) and LCX 15(14.4%). Left Main Coronary Artery is involved in 3 patients (2.9%). 6 (5.8%) patients suffered from cardiogenic shock either at admission or during hospital stay. Total In hospital mortality was seen in 3 (2.9%) patients. Conclusions: Among young patients (<45 years old) with STEMI who underwent PPCI in underdeveloped country majority are males and smoking is the most prevalent risk factor. Single vessel disease and LAD involvement is the most common angiographic finding and they have favorable in-hospital outcome.

Epicardial Fat Volume Assessed by Multi-Detector Computed Tomography and it’s Relation with the Severity of Coronary Artery Disease

Background Recent studies have suggested that fat disposition in epicardial tissue may be a predictor of the severity of coronary artery disease (CAD). Epicardial adipose tissue (EAT) is defined as the adipose tissue located between the outer wall of the myocardium and the visceral layer of pericardium, surrounding the heart and the coronary vessels. EAT is closely related to the adventitia of the coronary arteries without a barrier that may directly influence the development and progression of atherosclerosis and CAD through pro-inflammatory mediators. Objective The aim of the work is to investigate the relation between epicardial fat volume (EFV) [assessed by multidetector computed tomography (MDCT)] and severity of CAD. Methods This cross sectional study was conducted on 40 patients referred for MDCT coronary angiography to assess their complaint. EFV was quantified during non-contrast phase and severity of CAD was assessed by segment involvement score (SIS) and segment stenosis score (SSS) during contrast phase at Nasr City Police Hospital in the period between August 2018 and April 2019. Results The 40 consecutive subjects consisted of 30 males (75%) and 10 females (25%) with mean age 56 ±10.27 years. Risk factors of atherosclerosis were analyzed among the studied population as followed; the BMI ranged between 24 and 30.9 kg/m2, hypertensive patients were 77.5%, diabetic patients were 55% and smokers were 67.5%. The laboratory finding of the studied group revealed that the serum LDL.C ranged between 70 and 218 mg/dl (Mean±SD =163.88±43.37, Median= 183.5). The serum HDL.C ranged between 30 and 62 mg/dl (Mean±SD = 41.45±9.87, Median= 37). The serum total cholesterol ranged between 136 and 280 mg/dl (Mean±SD = 214.35± 35.51, Median= 224). The serum triglycerides ranged between 110 and 215 mg/dl (Mean±SD = 164.13±27.38, Median= 173).The serum creatinine ranged between 0.8 and 1.8 mg/dl (Mean±SD = 1.12±0.19, Median= 1.1). 17.5% of the studied patients had normal coronaries while 37.5% had single vessel disease and 45% had multi-vessel disease. There was a significant relationship between EFV and CAC score (p = 0.011, r = 0.397), a highly significant relationship between EFV and SSS score (p = 0.001, r = 0.518) and significant relationship between EFV & SIS score (P = 0.003, r = 0.459). Patients with normal coronary arteries were noted to have a lower EFV value than those with coronary lesions (highly significant relationship, p = 0.004) either single vessel disease or multi-vessel disease. There is no significant difference between the effects of EFV on number of diseased coronaries either single vessel disease or multi-vessel disease. Conclusion EFV increased in patients with both significant coronary artery stenosis or coronary calcification. EFV is considered an independent risk factor for CAD.

Prospective analysis of risk factors and angiographic profile in women with coronary artery disease –A hospital based study

Background: In order to facilitate diagnosis and timely intervention, it is essential to understand the presentation pattern of cardiac symptoms, and distribution of risk factors in women with Coronary Artery Disease (CAD). However, limited data is available regarding the salient features of CAD in women like distribution of risk factors and anatomical extent. Aims and Objective: The purpose of the present study was to determine the clinical and risk factor profile of women admitted with CAD and to analyze their angiographic findings in relation to the clinical presentation and risk factors in a tertiary care referral center of eastern India. Materials and Methods: In this study we prospectively analysed risk factors and angiographic patterns of 140 consecutive female patients who underwent coronary angiography for suspected CAD over a period of 2 years. Results: CAD most commonly affected females of age group >60yrs with higher incidence among postmenopausal as compared to premenopausal women. Unstable angina was the commonest presentation among patients with normal coronaries as well as obstructive CAD.A substantial percentage of women presenting with anginal pain were angiographically normal. Hypertension was the most common associated risk factor followed by diabetes, elevated total cholesterol, high LDL & low HDL. Most common coronary angiography finding was single vessel disease. On analysis, diabetes mellitus, elevated cholesterol, elevated LDL & triglycerides were most commonly associated with triple vessel disease. Conclusion: The incidence of CAD in females increased with age. Single vessel disease was the commonest presentation with Left Anterior Descending Artery, the most frequently involved vessel.

To Determine the Frequency of Extent of Coronary Artery Disease (CAD) with Troponin-I level >10 folds ULN in NSTEMI Patients at Tertiary Care Hospital

Introduction: Higher levels of troponins >10 folds of upper normal limits (UNL) are considered as high-risk patients on coronary angiography sufferers having high levels of troponin-I (>10 folds upper limit normal level) had extra three-vessel coronary artery disease involvement. Objectives: To determine the frequency of degree of cardiovascular disease with Troponin-I level >10 folds ULN in NSTEMI patients at tertiary care hospital. Methodology: It is a cross-sectional study comprising of a total 800 patients recruited from the Department of Cardiology, National Institute of Coronary Disease, Karachi Pakistan based on Exclusion/Inclusion criteria. Results: There are 678 male as well as 122 female patients. The mean troponin-I level was 15.00±6.82 ng/ml. Single vessel disease found in 25.25% cases, two vessel diseases were observed in 37.75% cases, and three vessel diseases were observed in 20% cases. 83% were found with extent of CAD findings on angiography. There have been 678 male and also 122 female patients. The mean troponin-I level was 15.00±6.82 ng/ml. Single vessel disease found in 25.25% cases, two vessel diseases were observed in 37.75% cases, and three vessel diseases were observed in 20% cases. 83% were found with extent of CAD findings on angiography. Conclusion: The higher troponin level found significantly associated with extent of CAD and three vessel disease. To understand the cardiovascular troponin condition of the sufferer as soon as feasible is crucial. Keywords: Extent of Coronary Artery Disease, NSTEMI, Troponin-I Level >10 Folds ULN

The 12-month period prevalence and cardiac manifestations of HIV in patients with acute coronary syndrome at a tertiary hospital in Cape Town, South Africa: a retrospective cross-sectional study

Background HIV-positive patients are increasingly being affected by non-communicable diseases such as coronary artery disease (CAD). Data from high-income countries (HICs) indicate that HIV-positive patients have different risk-factor profiles for acute coronary syndrome (ACS) as well as different cardiac manifestations of this syndrome compared to HIV-negative patients. There is limited data from Sub-Saharan Africa (SSA), and particularly from South Africa with the biggest HIV epidemic in the world. The objective of this study was to determine the 12-month period prevalence of HIV in patients with ACS and to compare the risk-factor profile, ACS presentation and management between HIV-positive and HIV-negative adults. Methods We included all patients hospitalised with ACS from 01 January to 31 December 2018 in a tertiary hospital, Tygerberg Hospital, in Cape Town, South Africa. The HIV-status of all patients was determined using routine clinical records. We performed multiple conditional logistic regression on HIV-positive and HIV-negative patients (1:3 ratio) to compare the risk factor profile, ACS presentation and management between the groups. Results Among 889 patients, 30 (3.4%) were HIV-positive (95% confidence interval (CI): 2.3–4.8). HIV-positive patients were younger, more frequently men, and had a lower prevalence of medical comorbidities and a family history of CAD. They were more likely to present with ST-elevation myocardial infarction (STEMI) [odd’s ratio (OR) (95% CI): 3.12 (1.2–8.4)], and have single-vessel disease [OR (95% CI): 3.03 (1.2–8.0)]. Angiographic and echocardiographic data, as well as management, did not differ between the groups. Among HIV-positive patients, 17 (65%) were virally suppressed (HIV viral load < 200 copies/mL) with a median CD4+ count of 271 cells/mm3. The majority (20, 67%) of HIV-positive patients were receiving antiretroviral therapy at the time of the ACS. Conclusions We found an HIV-prevalence of 3.4% (95% CI 2.3–4.8) in adults with ACS in a high endemic HIV region. HIV-positive patients were younger and more likely to present with STEMIs and single-vessel disease, but had fewer CAD risk factors, suggesting additional mechanisms for the development of ACS.

Role of Heart Rate Variability Testing in Predicting Coronary Stenosis in Non-Acute Clinical Setting

BACKGROUND Reduced heart rate variability (HRV) is associated with an increased risk of cardiovascular morbidity and mortality. The aim of the study was to determine whether reduced HRV is predictive of angiographic coronary artery disease (CAD) METHODS This study was done among 71 clinically stable subjects who underwent elective coronary angiography for diagnosis or pre-operative evaluation. High frequency (HF; 0.15 – 0.40 Hz), low frequency (LF; 0.04 – 0.15 Hz), LF / HF ratio, total power ≤ 0.4 Hz were used as the conventional indices of HRV. Analysis of variance (ANOVA) and chi square test was used to assess the statistical analysis. Statistical significance analysis was carried out with International Business Machines Statistical Package for the Social Sciences (IBM SPSS) version 22. RESULTS Out of 71 subjects, only 58 were available for final analysis. 20 subjects had normal coronary arteries, 19 had single vessel disease and remaining 19 had multi vessel disease. The HF power of HRV showed decreasing trend as the severity of angiographic stenosis increased. The median values of LF power for single vessel disease and multi vessel disease were 148 ms2 and 160 ms2 respectively. The group without coronary artery disease has a median of 215 ms2 for LF power. The median HF power was lower in single vessel disease group (133 ms2 ) compared to group with normal coronaries (139 ms2 ) and it was very low in multi vessel disease (81 ms2 ) group compared to group with normal coronaries. CONCLUSIONS A weak association of HF and LF power of HRV with degree of angiographic stenosis was observed. KEYWORDS Heart Rate Variability, Coronary Angiogram, Angiographic Stenosis

Study of coronary artery disease in young population of Central India

Background: Coronary heart disease is the most common indication among cardiovascular diseases (CVD) and a major cause of mortality and morbidity. According to global burden of disease study estimates, nearly 24.8% of all deaths in India are attributable to CVD. Objectives of the current research study were to establish a correlation between varied risk factors and coronary artery disease (CAD), to determine angiographic characteristics individually in patients with multiple risk factors and to evaluate number of vessels involved in CAD.Methods: Present study was a prospective study conducted on 50 patients with acute coronary syndrome below 40 yrs of age admitted at the department of cardiology, Superspeciality hospital, NSCB medical college, Jabalpur. All patients included in the study were subjected to coronary angiography. The angiographic characteristics such as extent of CAD (characterized by the number of vessels with angiographic lesions) were determined.Results: Current study findings depicted that most of CAD patients were in age group of 36-40 years. Proportion of males was higher than females. One-fifth of patients were diabetics and 34.0% were hypertensive. It was observed that 54.0% CAD patients had history of smoking and 32.0% had history of premature CAD. Most of patients exhibited single vessel disease in CAG and left anterior descending (LAD) was the most commonly involved artery.Conclusions: Smoking was concluded as one of the major risk factor associated with CAD and most of patients exhibited single vessel disease, LAD being the most commonly involved artery. Significant number of patients with family history depicted high risk for CAD. Males were concluded to be more prone to CAD at younger age.

Angiographic profile of young patients (≤ 40 years) in a tertiary care center of Nepal

Background: With rise in prevalence of conventional risk factors like diabetes, hypertension, smoking, dyslipidemia and obesity the incidence of coronary artery disease in young patients have increased in the recent decades even in developing world. There have been multiple studies done in Nepal studying the angiographic profile of coronary disease in general population. However, only few studies has been done till date on the angiographic profile in the young population in our country. Aims and Objectives: In this study, we aim to determine the angiographic profile of young patient ≤ 40 years in a tertiary care centre of Nepal. Materials and Methods: A retrospective analytic study was done in Shahid Gangalal National Heart Centre from January 2019 to December 2019. Individuals of both genders with age ≤ 40 years who underwent coronary angiography were included. Results: Total 109 patients were included. Out of 109, 89 were male and 20 were female. The mean age for male was 35.55 ± 4.31 and for female was 38.55 ± 1.90 (P = 0.003). Among 61 (55.96%) patients who had significant coronary artery disease, 33 patients (30.27%) with single vessel disease, 15 patients (13.76%) had double vessel disease, and 13 patients (11.92%) had triple vessel disease. Left anterior descending (LAD) artery was found to be most frequently involved in all patterns of Coronary artery disease (CAD). Smoking was the most common coronary risk factor present in 29.3% of patients followed by hypertension, family history of premature CAD and diabetes in 14.6%, 7.5% and 5.5% of patients respectively. Overall, the prevalence of smoking was more in males (31.4%) than in females (20%). Conclusion: Single vessel disease (SVD) was most prevalent in young patients with significant CAD. LAD is the most commonly involved coronary artery followed by Right coronary artery (RCA) and Left Circumflex (LCX).

Complete revascularization of non-culprit lesions in stemi is associated with improved myocardial salvage and reduced microvascular obstruction: a cardiac magnetic resonance study

Background The COMPLETE trial showed that routine and complete Percutaneous Coronary Intervention (PCI) of non-infarct related artery (non-IRA) lesions in STEMI was associated with a significant reduction in the rates of death or new myocardial infarction. However, whether this benefit is related to improved myocardial salvage and left ventricular (LV) function is unknown. Methods We prospectively included 465 patients with first STEMI reperfused by primary PCI. Late gadolinium-enhanced Cardiac Magnetic Resonance (CMR) was obtained during admission to measure the area at risk (AAR), IRA-infarct size (IS) as % LV mass, and myocardial salvage index (MSI) as % of AAR. The study was repeated in 392 of them at 6 months follow-up to compute LV volumes and ejection fraction (EF). Results Patients with three-vessel disease had larger IS than those with two or single vessel disease (25.4±14.5% vs 19.0±13.1% vs 19.0±12.8% LV mass respectively, p&lt;0.05), despite no differences in AAR (33±11% LV mass for all). Accordingly, MSI decreased progressively for one, two or three-vessel disease (42.4±31.4 vs 41.5±30.6 vs 25.1±31.3% AAR respectively, p&lt;0.01). The number of myocardial segments with microvascular obstruction (MVO) was also higher for three-vessel disease (1.9±1.9) than for two (1.1±1.7) or single-vessel disease (1.2±1.8), p&lt;0.05. Mean follow-up EF also decreased progressively with the number of vessels involved (50.7±9.4, 49.1±11.4 and, 44.4±11.2% respectively, p&lt;0.01). A total of 183 patients had multivessel disease. Among them, those with complete revascularization (n=51) had larger MSI (46.4±35.2 vs 34.5±29.3% AAR, p&lt;0.04) and were less likely to have MVO phenomenon (28.6 vs 49.2%, p&lt;0.05). However, no significant differences in the change in EF was observed between both groups (ΔEF:+4.4±6.2 vs +4.3±6.2%, p=0.985 for the interaction). Conclusion The presence and extent of multivessel disease influence myocardial salvage and MVO following primary PCI in STEMI. Improvement in myocardial salvage in the IRA territory and a reduction in microvascular obstruction may mediate the beneficial effects of complete revascularization. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fundaciό La Marato TV3 2015303132, FIS PI15/00531. Partially funded with FEDER funds.