ABSTRACT
Chronic Total Occlusion (CTO) intervention is a challenging area in interventional cardiology. Presently about 70% of CTO interventions are successful. Materials and methods This was a single center prospective study of a cohort of all patients undergoing percutaneous coronary intervention (PCI) as elective or adhoc procedure for CTO from August 2014 to June 2015. Only antegrade CTO interventions were included. In all patients the following data were recorded. Results A total of 210 (8.9% of total PCI (2353) during the study period) CTO patients were followed up. The mean age was 56.54 ± 8.9. In the study sixty nine patients (32.9%) presented with chronic stable angina and rest of the patients had history of acute coronary syndrome of which 22.9% (n = 48) had unstable angina (UA) or non ST elevation myocardial infarction (NSTEMI) and 44.2% (n = 93) had ST Elevation Myocardial Infarction (STEMI). In those with history of ACS, 64.78% (n = 92) had ACS during the previous year and remaining 35.22% (n = 49) had ACS prior to that. Single vessel CTO was seen in 89.5% (n = 188) and two vessel CTO in 10.5% (n = 22). LAD was involved in 36.7% (n = 77), RCA in 48.1% (n = 101), and LCX in 15.2% (n = 32). Procedural success in the first attempt was 68.1% (n = 143), which increased to 71.42% (n = 150) after the second attempt. CTO interventions were more frequently successful when the calcium was absent or minimal (p-0.05), CTO length was <10 mm (p < 0.01) and good distal reformation (p < 0.01).
ABSTRACT
Objectives To compare the clinical presentation, clinical profile and survival of two groups of endomyocardial fibrosis patients. Methods The study was a prospective cohort study, or a prospective case series, comparing all consecutive echocardiographically proven patients with endomyocardial fibrosis seen in Medical College Trivandrum with the patients seen in Medical College Hospital, Alappuzha(Alleppey) (or TD Medical College). In all patients the clinical details like age, sex, type of endomyocardial fibrosis, the presence of anaemia, eosinophilia, neutrophilia and type of rhythm(Sinus or atrial fibrillation) etc were compared by both simple X2 and by Kaplan Meier survival curves. Results The mean age and the sex distribution was same in both places Briefly the incidence of biventricular endomyocardial fibrosis was more from Trivandrum than Alleppey, 64.9% vs 14.3% (p < 0.0.001), the incidence of atrial fibrillation was more in Trivandrum 44.2% vs 16.3%. (p < 0.001)The overall survival of Trivandrum patients was poorer (p < 0.0001). The six year survival was 61% in the Trivandrum population whereas it was 91.5% in the Alleppey population. Conclusions These differences may have been due to the better nutrition of the Alleppey patients due to a higher exposure to fish compared to the Trivandrum population. Better nutrition would protect against Magnesium deficiency and prevent the absorption of Cerium in the patients from Alleppey, compared to those from Trivandrum.