Epidemiology, outcomes and coronary angiography findings of patients following out-of-hospital cardiac arrest

Objectives: Out-of-hospital cardiac arrests [OHCAs] are a leading cause of death worldwide. However, data regarding the management and outcomes of affected patients are lacking in the Middle East. The current study aimed to present the angiographic findings and outcomes of patients presenting with OHCA in Muscat, Oman

Methods: This retrospective study took place between January 2012 and December 2016 at the Sultan Qaboos University Hospital [SQUH], Muscat, Oman. All adult patients who presented following an OHCA to the Emergency Department of SQUH during the study period were included. Demographic and clinical data were collected from electronic medical records

Results: A total of 216 patients were included in the study. The majority [63.9%] presented after having collapsed, while 22.3% presented with chest pains. Asystole was the most frequent initial cardiac rhythm [62.5%], with only 10% having ventricular tachycardia/fibrillation. Very few patients [1.4%] had received cardiopulmonary resuscitation [CPR] prior to presentation. In total, 85 patients [39.4%] returned to spontaneous circulation [RSC]; of these, post RSC electrocardiography revealed an ST-segment elevation in 41.2% and normal findings in 23.5%. There were 63 patients who underwent coronary angiography, with 28 requiring stenting. Overall, 13% of patients survived and were discharged, although three survivors suffered permanent hypoxic brain damage

Conclusion: The overall survival rate of patients who had experienced an OHCA was low. Education programmes should focus on the benefits of immediate CPR for individuals experiencing an OHCA, with more opportunities for CPR training to be made available to the general public in Oman

Troponin testing in the emergency department: real world experience

Objectives: The aim of this study was to examine patterns of troponin testing in the emergency department of a large tertiary care hospital in Oman and to determine its effect on patient management, including length of hospital stay [LOS]

Methods: This retrospective study analysed the medical records of all adult patients undergoing troponin testing in the emergency department of the Sultan Qaboos University Hospital, Muscat, Oman, during the month of July 2015. Patients who presented with an ST-elevation myocardial infarction were excluded

Results: A total of 4,845 patients attended the emergency department during the study period; of these, troponin tests were ordered for 588 patients. The majority of the patients had negative troponin test results [81.3%]. Chest pain, palpitations and breathlessness were the most common presenting complaints for those with positive troponin results. However, 41.8% of patients did not have any cardiac symptoms. Individuals with positive troponin tests had a significantly longer LOS compared to those with negative tests [mean: three versus one day; P = 0.001]. In total, only 28.2% of those with positive troponin test results had final diagnoses associated with a cardiac condition, such as heart failure, an acute coronary syndrome [ACS], atrial fibrillation or other types of arrhythmia

Conclusion: A positive troponin test was associated with increased LOS; however, only a small proportion of these patients had a final diagnosis associated with a cardiac condition. Guidelines should be provided to ensure that troponin testing is performed only in cases where an ACS is suspected

Asymptomatic permanent left bundle branch block [LBBB] complicating diagnostic left heart catheterisation

This case report describes a routine diagnostic left heart catheterisation [coronary angiography, aortography and left ventriculography] procedure at Sultan Qaboos University Hospital, Oman, which was complicated by the development of new asymptomatic, but permanent, left bundle branch block that was observed incidentally towards the end of the procedure. The patient was completely asymptomatic and haemodynamically stable throughout the procedure and afterwards. Urgent investigations, immediately after the procedure, including routine blood, serial cardiac troponin I, serial electrocardiograms, chest X-ray, and urgent echocardiography were normal and failed to show any possible causation of the LBBB. The results of left heart catheterisation showed two vessel coronary artery disease and severe mitral valve regurgitation. After eight days, the patient went on to have coronary artery bypass surgery and mitral valve replacement surgery both of which were successful. To the best of our knowledge, this is the first case report to describe the occurrence of permanent LBBB after left heart catheterisation. This report describes the case and reviews the literature for the incidence and implications of such a complication

Retrieval of dislodged central venous pressure catheters: early experience with three case presentations

Central venous catheters [CVP] are frequently used in clinical practice. Occasionally, catheters may become dislodged. If percutaneous retrieval fails, then cardiothoracic surgery is necessary to retrieve the fractured catheter and avoid potential complications. This report describes early experiences of three different modes of broken catheter retrieval: the first by use of a snare catheter; the second by surgery and the third during bypass surgery. We conclude that broken fragments of catheters that lodge in the right side of the heart or pulmonary circulation can be retrieved most of the time percutaneously by snare catheters

Comparative study of the radial and femoral artery approaches for diagnostic coronary angiography

Femoral artery access is the standard approach for coronary procedures; however, the radial approach has gained sound recognition as an alternative to femoral access. We present our early experience with the transradial approach. A prospective, non-randomised study of 221 candidates for diagnostic coronary angiography was carried out at Sultan Qaboos University Hospital, Oman between December 2008 and April 2009. The patients had their procedure performed from radial or femoral access according to operator discretion and the results were compared. Femoral and radial groups included 116 and 105 patients respectively. Results: Radial access was associated with a significantly higher rate of procedural failure [17.1%] versus 0% in femoral group [p=0.001]. There were no local vascular complications in the radial group as opposed to 12.1% in the femoral group [p < 0.01]. Hospital length of stay was significantly reduced in the radial group [4.06 versus 23.5 hours, p < 0.01]. Total procedure time was longer in the radial group [23.7 +/- 13.7 min versus 20.1 +/- 7.4 min, p < 0.001], but radiation exposure was similar in both groups. There was a trend for a higher risk of major adverse cardiac events noticed in the femoral group; however, it did not reach statistical significance. The transradial approach for coronary angiography is associated with significantly reduced local vascular complications and shorter hospital stays. The femoral approach is the standard access site for coronary angiography; however, interventional cardiologists should acquire experience in the radial approach as an alternative in specific situations