Vascular complications following cardiac catheterization at Jordan University Hospital

Objective: This study evaluates the rate of vascular complications following diagnostic cardiac catheterization and percutaneous intervention [PCI] at Jordan University Hospital

Methods: We reviewed the records of 1000 consecutive patients who underwent cardiac catheterization or PCI. Vascular complications including: minor hematoma > 5 cm in diameter, pseudoaneurysm, arteriovenous fistula and major bleeding with a hemoglobin drop >/=3 gm/dl or bleeding requiring transfusion, limb ischemia and death related to the vascular complication. In addition, clinical variables associated with increased risk of vascular complications were recorded including age, hypertension, diabetes mellitus, chronic kidney disease, congestive heart failure, indication for the procedure, emergency vs. elective, and diagnostic catheterization vs. PCI

Results: 1000 consecutive cases [746 catheterization, and 256 PCI] that were performed in the period from January 1st to Aug 25th 2011 were evaluated. There were six [0.6%] complications: one major [bleeding; requiring blood transfusion] and five minor [3 hematomas and 2 pseudoaneurysms] . A higher vascular complication rate was recorded in certain groups, PCI versus diagnostic catheterization [1.9% vs. 0.1%, P=0.005], emergency versus elective procedures [6.8% vs. 0.3% P= 0.001], and myocardial infarction versus angina [4.3% vs. 0.2%, P= 0.002]. None of the clinical variables studied in this series had an association with increased risk for vascular complications

Conclusions: Vascular complications rate following cardiac catheterization and PCI was comparable to other published series, suggesting that manual compression with proper monitoring by doctors and nurses continues to be a safe procedure. PCI, emergency procedures, and myocardial infarction carried a significantly higher vascular complication rate

prognostic implications of timi risk scores in jordanian patients with acute coronary syndrome results from the glucometabolic abnormalities in acute coronary syndrome in Jordan [GLORY] study

Western studies have shown that TIMI [Thrombolysis In Myocardial Infarction] risk scores predict adverse events in patients with non ST-elevation acute coronary syndrome [NSTEACS] and ST-elevation myocardial infarction [STEMI]. Whether this also applies to Jordanian patients is largely unknown. We prospectively followed up 656 patients with ACS for total mortality, combined events of death, nonfatal MI or urgent coronary revascularization up to one year after admission. Of the whole group, 472 patients [72%] had NSTEACS, and 184 patients [28%] had STEMI. Among NSTEACS patients, 31.0% had a low risk score [total points 0 - 2 of 7], 43.5% had an intermediate risk score [total points 3 - 4], and 25.5% had a high risk score [total points 5 - 7]. In-hospital mortality was not different in the respective risk score groups [1.4%, 0.5%, and 3.4%, p = 0.123]. At 1 year, mortality was significantly higher in the high risk score group [12.8%] compared with the intermediate [4%] and low [1.4%] risk groups [p = 0.001]. Among STEMI patients, 58.6% had a low risk score [total points 0 - 3 of 13 - 14], 31.0% had a low intermediate risk score [total points 4 - 6], 8.0% had a high intermediate score [total points 7 - 9], and 2.4% had a high risk score [total points > 10]. In-hospital mortality rate was significantly higher in the two intermediate risk score groups [7.4%, 14.3%, respectively] and the high risk score group [50%] compared with the low risk score group [1.0%, p = 0.001]. The high risk and the two intermediate risk groups also had higher one-year mortality [75%, 28.6% and 16.7%, respectively] than the low risk group [3.9%, p = 0.001]. Similarly, composite events occurred at a significantly higher rate in patients with high risk scores than intermediate or low risk scores among NSTEACS and STEMI patients. TIMIRisk Scores and Prognosis in Jordan. Ayman J. Hammoudeh et al. In Jordanian ACS patients, high TIMI risk scores were associated with a high risk of cardiovascular events. Such patients are candidates for early aggressive therapeutic strategies

Serum homocysteine levels in patients with acute myocardial infarction in Jordan

To examine the homocysteine level in Jordanian patients with acute myocardial infarction. Plasma fasting homocysteine levels were measured in 90 patients with acute myocardial infarction and compared to 90 age-, sex-, and smoking habit matched control subjects free of clinical coronary disease. Homocysteine [mmol/l] levels were significantly higher in patients compared to controls [18.5 +/- 7.8 v 12.0 +/- 8.4; p=0.002]. The result of this study indicates that homocyteine level is high in patients with acute myocardial infarction and it may be a risk factor for coronary heart disease in Jordanian population. Public health education about homocysteine and its reduction by increasing supplements of folate and vitamin B may reduce the incidence of coronary artery disease in Jordanian population

Echocardiographic findings in dialysis patients

In order to evaluate the echocardiographic changes in haemodialysis patients, an observational study was performed in the cardiology and nephrology departments at the University Teaching Hospital. Eighty patients on regular haemodialysis underwent transthoracic echocardiogram for systolic, diastolic, wall thickness chamber diameter, calcification pericardial space and Doppler-flow assessment. The echocardiographic abnormalities were diastolic dysfunction [88%] left ventricular hypertrophy [LVH] [84%] left atrial enlargement [62%], left ventricular dilatation [55%], mitral valve calcification [47%], depressed left ventricular function [35% and pericardial effusion [18%]. A normal echocardiogram was present in 9 [11%] patients. Echocardiographic abnormalties were found to be common in our haemodialysis and some were potentially treatable and preventable. Early evaluation and assessments are recommended in all maintenance dialysis patients by echocardiogram

Echocardiography in evaluating young hypertensive patients in Jordan

Objective-To identify echocardiographic changes in a newly diagnosed, untreated young hypertensive patients. Subjects :A 110 newly diagnosed untreated hypertensive patients. Transthoracic echocardiogram was performed for all untreated subjects and a control group for structural and Doppler abnormalities. Results:From 110 of untreated young hypertensive patients, 25[23%] had increased interventricular septal thickness and 23 [21%] had LV hypertrophy. Left atrial size and ejection fraction was similar to the control group. Diastolic function parameters showed increased peak atrial filling velocity Avmax in hypertensive subject and prolonged deceleration time and decrease E/A ratio in hypertensive with hypertrophy in comparison to control group. Conclusions: structural cardiac involvement is a common finding in newly diagnosed young untreated hypertensive patients in Jordan. Echocardiography is recommended for newly diagnosed hyperetensive patients for early detection of cardiac involvement and proper treatment