ABSTRACT
Objectives: In acute coronary syndrome (ACS) patients the focus is on major conventional risk factors - CRF [diabetes, hypertension, elevated low-density cholesterol (LDL-C) and smoking] whereas others - specific metabolic risk factors - MRF [high-density lipoprotein cholesterol (HDL-C), body-mass index (BMI), waist-hip ratio (WHR), and triglycerides, and HbA1c get less attention. Methods: This is a prospective caseecontrol observational study from 15 tertiary care hospitals in India. CRF and MRF in patients presenting with first incidence of ACS (n ¼ 2153) were compared with matched controls (n ¼ 1210). Results: Propensity score matching (PSM) yielded 1193 cases and matched 1210 controls. Risk factor prevalence in cases vs. controls were CRF: hypertension - 39.4% vs 16.4% (p < 0.0001), diabetes - 42.6% vs 12.7% (p < 0.0001), smoking - 28.3% vs 9.3% (p < 0.0001) and elevated LDL-C - 70.2% vs 57.9% (p < 0.0001). MRF: High BMI - 54.7% vs 55.1% (p ¼ 0.84), increased waist: hip ratio 79.5% vs 63.6% (p < 0.0001), high HbA1c - 37.8% vs 14.9% (p < 0.0001), low HDL-C - 56.2% vs 42.8% (p < 0.0001) and elevated triglycerides - 49.7% vs 44.2% (p ¼ 0.007). Adjusted Odds ratios by multivariate analysis were CRF: hypertension - 2.3 (p < 0.001), diabetes - 4.7 (p < 0.001), high LDL-C - 3.3 (p < 0.001) and smoking6.3 (p < 0.001). MRF: High waist: hip ratio - 2.4 (p < 0.001) high HbA1c - 3.2 (p < 0.001), low HDL-C 2.2 (p < 0.001) and elevated triglycerides - 0.878 p ¼ 0.17. Conclusion: In India, the risk of ACS conferred by specific metabolic risk factors (High waist: hip ratio, Low HDL-C and High HbA1c) is comparable to that caused by CRF
ABSTRACT
Background: No reflow phenomenon observed during catheter intervention has been associated with poor cardiovascular outcomes. Assessment of filling defect by myocardial contrast echocardiography (MCE) correlates with no reflow. Limited studies are available for the same. This study was designed to look for impact of type of therapy for revascularization (whether percutaneous coronary intervention or thrombolysis) and its evaluation by MCE and follow up echocardiography parameters.Methods: Total 50 consecutive patients of ST-elevation myocardial infarction (STEMI) were taken study including recent STEMI (within 7 days). After all routine investigations patient underwent coronary angiography and percutaneous coronary intervention (PCI) procedure. Following completion of procedure, thrombolysis in myocardial infarction (TIMI) flow, TIMI frame count, and myocardial blush grade were calculated and noted. Post revascularization contrast echocardiography was done after patient stabilization. Findings were correlated with cath-lab parameters applying appropriate statistical tests. Follow up was planned after 30 days.Results: 50 consecutive patients admitted with acute myocardial infarction (MI) or recent MI (0-7 day) who underwent primary PCI - 82% (n=41) or thrombolysed with various thrombolytic agents - 18% (n=9). Mean age of the study group was 55.02±12.65 years. There was significant association in between TIMI 3 flow and absence of filling defect in MCE (p=0.03), but no significant association found in between revascularization therapy (Either PCI or Thrombolysis) and filling defect in MCE (p=0.08).Conclusions: Our study found good correlation between myocardial contrast score with angiographically measured TIMI flow and improved echocardiographic findings on follow up.