ABSTRACT
In the context of ARVC, a systematic review of the validation of the ARVC risk score can provide insights into the accuracy and reliability of this score in identifying patients at high risk of ARVC. Digital databases were searched to identify the relevant studies using Medical Subject Headings (MeSH). A total of 8 studies were included in this systematic review. A total of 8 studies were included in this review. The review found that the sensitivity of the ARVC risk scores ranged from 80 to 95%, and the specificity ranged from 31 to 79%. The PPV was 55%, and the NPV was 88%. The ARVC score provided a C-index for a 5-year VA risk prediction of 0.84 [95% CI (0.74–0.93)] and a Harrell C-index of 0.70 (95% CI 0.65–0.75). The calibration slope was 1.01 (95% CI 0.99–1.03). ARVC score demonstrated a significant event 5-year threshold between 15 and 20% and the classical ARVC 5-years/freedom-from-VA rate was 0.76(0.66–0.89) and the non-classical form 5-years/freedom-from-VA rate was 0.58 (0.43–0.78). In conclusion, the validation of ARVC risk scores is an essential step toward improving the accuracy of ARVC diagnosis and risk stratification. Further studies are needed to establish the accuracy and reliability of ARVC risk scores and to address the limitations of the current evidence.
ABSTRACT
Background - Numerous meta-analysis have been published and on the basis of the results of the some or all of the more than 33 trials evaluating intravenous streptokinase for acute myocardial infarction. All of these reviews demonstrated a consistent, statistically significant reduction in mortality for patients with acute myocardial infarction who were treated with intravenous streptokinase. Objectives - Intravenous streptokinase clearly confers a protective effect against early mortality in patients with acute myocardial infarction, with this initial hope that the administration of thrombolytics to patients with evolving acute myocardial infarction will prevent infarct complications. We conducted prospective study to observe the rate of complications as a whole in patients who could not get the thrombolytic therapy. Setting - This study was conducted in the coronary care unit and out patient Department of Cardiology Bahawal Victoria hospital Bahawalpur affiliated with Quaid-e-Azam Medical College Bahawalpur. Methods - This observational study was carried out in 960 patients fulfilling the diagnostic criteria for acute myocardial infarction. These patients were prospectively followed for clinical end points during the hospitalization and 90 days follow up period. Streptokinase 1.5 million units was used as a thrombolytic agent in the patients fulfilling the eligibility criteria. Results - A total of 960[21.22%] patients with acute myocardial infarction were assessed for the complications of myocardial infarction with or without thrombolytic therapy. Male and female patients were 664 [69.16%] and 296[30.83%] respectively. Mean age of patients with myocardial infarction was 57.30 years. Anterior myocardial infarction was diagnosed in 680[70.83%] patients and inferior wall myocardial infarction was diagnosed in 280[29.16%] patients. Streptokinase was given in 500[52.08%] patients while 460[47.9%] did not get it. There was statistical significant difference of complications as a whole with p value of < 0.001. Conclusion - Thrombolysis is the first line between life and death and now it has become the established fact beyond doubt in the treatment of acute myocardial infarction. The advent of streptokinase has led to substantial changes in clinical practice of managing acute myocardial infarction especially evolving one. The magnitude of the treatment effect lowers the risk of mortality and hospital stay