ABSTRACT
Effective risk stratification is integral to management of acute coronary syndromes [ACS]. The Thrombolysis in Myocardial Infarction [TIMI] risk score for ST-segment elevation myocardial infarction [STEMI] is a simple integer score based on 8 high-risk parameters that can be used at the bedside for risk stratification of patients at presentation with STEMI. To evaluate the prognostic significance of TIMI risk score in a local population group of acute STEMI. The study included 160 cases of STEMI eligible for thrombolysis. TIMI risk score was calculated for each case at the time of presentation and were then followed during their hospital stay for the occurrence of electrical and mechanical complications as well as mortality. The patients were divided into three risk groups, namely 'lowrisk', 'moderate-risk' and 'high-risk' based on their TIMI scores [0-4 low-risk, 5-8 moderate-risk, 9-14 high risk]. The frequencies of complications and deaths were compared among the three risk groups. Post MI arrhythmias were noted in 2.2%, 16% and 50%; cardiogenic shock in 6.7%, 16% and 60%; pulmonary edema in 6.7%, 20% and 80%; mechanical complications of MI in 0%, 8% and 30%; death in 4.4%, 8%, and 60% of patients belonging to low-risk, moderate-risk and high-risk groups respectively. Frequency of complications and death correlated well with TIMI risk score [p=0.001]. TIMI risk score correlates well with the frequency of electrical or mechanical complications and death after STEMI
ABSTRACT
PTSMA causes non-surgical ablation of hypertrophied septal myocardium in cases of Hypertrophic Obstructive Cardiomyopathy [HOCM] by occlusion of septal branch of left anterior descending artery using pure alcohol. Nine patients including 5 men and 4 women ages between 30-56 years underwent this procedure at Punjab Institute of Cardiology, Lahore between May 1998 to December 1999. First septal perforator alone was injected in seven patients while two patients needed injection to the second septal perforator as well because of inadequate drop in LVOT gradient after first septal perforator injection. Complete reduction of LVOT gradient in 1 [11.1 percent] case followed by > 50 percent LVOT gradient reduction in 6 [66.6 percent] and 20-49 percent LVOT gradient reduction in 2 [22.2 percent] of the cases was seen. The average creatinine kinase peak values were 89[ +/- 35[] U/L [MB fraction 125 +/- 60 U/L] at 12 hours post procedure. One patient developed VF during the procedure which was successfully treated. Conduction disturbances were the main complications of the procedure and included right bundle branch block [RBBB] in 5 [55.5 percent], trifasicular block in 3 [33.3 percent] and AV dissociation in 1 [11.1 percent] of the cases. Trifasicular block and AV dissociation were transient requiring pacing for 2-3 days and did not require permanent pacemaker. There was no procedural or in hospital mortality. The patients were discharged 5-7 days after procedure. 8 patients followed up after three months and echocardiogram showed further improvement in LVOT gradient with 2 [25 percent] cases having no LVOT gradient, 4 [50 percent] cases having LVOT gradient reduction >50 percent while 2 [25 percent] cases showed LVOT gradient reduction between 20-49 percent. PTSMA has emerged as a promising new technique for reduction of LVOT gradients in patients of hypertrophic obstructive cardiomyopathy. Compared with surgical myomectomy this procedure is controlled in terms of area affected. Possible complications are arrhythmias and conduction disturbances, which may require pacemaker implantation. Long-term follow up of larger series of patients is required for comparison with conventional forms of therapies