ABSTRACT
Background. India has the highest burden of coronary artery disease in the world. It also has a higher rate of STsegment elevation myocardial infarction than that in developed countries. Primary percutaneous coronary intervention is an effective treatment, yet little is known about its feasibility and outcome in India. We studied the outcomes of primary percutaneous coronary intervention at an Indian tertiary care centre. Methods. We did a prospective observational study of 1000 consecutive patients with ST-segment elevation myocardial infarction, who were treated with primary percutaneous coronary intervention from December 2010 to May 2014 at Sri Venkateswara Institute of Medical Sciences, Tirupati, India. Patient characteristics, procedural details, inhospital and 3-month adverse events were assessed. Results. The mean (SD) age of our patients was 54.5 (11.3) years. Among the study population, 82.9% were men, 32.8% had diabetes mellitus, and 36.3% had hypertension. Only 18.2% of the patients came to hospital in an ambulance, and 6% were in cardiogenic shock. Most frequently, the left anterior descending artery was the infarctrelated artery (57.9%). The mean (SD) time from onset of symptoms to arrival at hospital was 369.6 (204.6) minutes and the mean door-to-balloon time was 58.6 (17.1) minutes. The in-hospital adverse event rate was 5.7% (mortality 3.6%, non-fatal reinfarction 0.9%, stroke 0.3%, major bleeding 0.9%). Patients without cardiogenic shock had an in-hospital survival rate of 99.1%. During 3 months of follow-up, 0.9% of patients died and 0.8% had non-fatal reinfarction. The 3-month survival rate was 95.5%. Conclusion. Primary percutaneous coronary intervention is feasible in India with an acceptable door-to-balloon time and low rates of adverse events despite longer time to presentation. Natl Med J India 2015;28:276–9
ABSTRACT
Background: Heart failure (HF) has become a main cardiac problem. Doppler echocardiography has been used to examine left ventricular (LV) diastolic filling dynamics. Limitations of this modality suggest the need for other objective measures of diastolic HF. Aim of the Study: The hypothesis of this study is to assess the utility of N-terminal pro-B type natriuretic peptide (NTproBNP) in the diagnostic evaluation of diastolic HF in comparison with tissue Doppler imaging (TDI) recordings. Methods: A prospective study was carried out between May 2010 and December 2011. Patients with signs and symptoms of HF with normal LV systolic function by 2D-echocardiography were recruited. M-mode and 2-dimensional images, left atrial volume index (LAVI), spectral and TDI of the mitral annulus were obtained for all the patients. NTproBNP levels were measured with a bedside immunoassay. Results: We found linear correlation between NTproBNP levels and grade of diastolic dysfunction (DD), LAVI, ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/E’) [r=0.72, p<0.001]. Patients with elevated left ventricular end diastolic pressure, defined as E/E’>15 (n =18), had the highest NTproBNP levels (3028±2674pg/mL). NTproBNP levels (4146±2887.43 pg/mL) were highest in patients with grade III DD. A receiver operator characteristic curve showed NTproBNP value, 286 pg/mL, the best cut-off for diagnosing diastolic HF with a sensitivity of 89% and a specificity of 100%. Conclusions: Plasma NTproBNP levels can reliably estimate LV filling pressures in patients with HF and normal systolic function which might help to reinforce the diagnosis of “diastolic HF”.
ABSTRACT
A young lady was found to have hemihypertrophy, scoliosis, subcutaneous swellings, patchy dermal hypoplasia, plantar hyperplasia and macrodactyly. These suggested a diagnosis of Proteus syndrome. She was also having unilateral generalized hypertrichosis. The association of Proteus syndrome and unilateral generalized hypertrichosis has not been reported in the literature.