Clinical comparison of different cardiovascular risk scores for cardiovascular risk prediction in Indian patients

Background: Cardiovascular diseases (CVD) are the main cause of mortality and disability in India. Early and sustained exposure to behavioral risk factors leads to development of CVD. The present study was conducted to compare different cardiovascular calculators for CVD risk assessment models in young Indian patients presenting with myocardial infarction.Methods: This study included 85 patients with myocardial infarction (MI). Their predicted 10-year risk of CVD was calculated using three clinically most relevant risk assessment models viz. Framingham Risk score (RiskFRS), American College of Cardiology/American Heart Association (RiskACC/AHA) and the 3rd Joint British Societies risk calculator (RiskJBS).Results: RiskFRS recognized the highest number of patients (15.4%) at high CVD risk while RiskACC/AHA and RiskJBS calculators provided inferior risk assessment but statistically significant relationship. RiskFRS and RiskACC/AHA (Pearson's r 0.870, p<0.001).Conclusions: RiskFRS seems to be as most useful CVD risk assessment model in young Indian patients. RiskFRS is likely to identify the number of patients at ‘high-risk’ as compared to RiskJBS and RiskACC/AHA.

Endovascular Balloon Occlusion Of The Aorta For Placenta Percreta During Cesarean Hysterectomy

The potential massive hemorrhage from placenta percreta requires large volumes of blood products to be transfused which are often not readily available for resuscitation and surgery, especially at rural centers. Multiple foreign case studies report the successful use of endovascular balloon occlusion of the aorta (EBOA) for the management of maternal hemorrhage. We present the first case of placenta percreta in India which was managed successfully by pre-operative placement of a balloon-tipped catheter in the aorta. Her hemodynamic status was well-controlled intraoperatively, and there were no post-operative complications. The surgical field was bloodless on balloon inflation allowing for surgical dissection and hemostasis; occult bleeders could be visualized and ligated by transiently deflating the balloon. Importantly, the transfusion requirements of this patient were drastically reduced. The authors propose that EBOA can be a staple modality in the pre-operative management of placenta percreta, especially in rural areas.