Left ventricular ejection fraction measurement using cardiovascular magnetic resonance imaging in patients with post-myocardial infarction: assessment of reproducibility by a cardiovascular radiologist and a trained technologist.

Background: Cardiovascular magnetic resonance imaging (CMR) has recently been accepted as a preferential method for evaluation left ventricular ejection fraction (LVEF). The LVEF analysis by CMR is usually performed by trained technologists in many institutions of Thailand. Objective: Assess the reproducibility of LVEF measured by a cardiovascular radiologist and a trained technologist using CMR in patients with post-myocardial infarction (MI). Methods: Twenty-one MI patients (18 men and 3 women) were recruited, where nine patients underwent CMR and left ventriculography to follow-up LVEF two times in six months. Both CMR and left ventriculography were examined within two weeks. LVEF from CMR were measured by a cardiovascular radiologist and a trained technologist and the correlation between the left ventriculography and CMR was determined. Results: In 30 CMR studies, interobserver reliability (intraclass correlation coefficient ICC=0.94) and intraobserver reliability (ICC=0.96) was excellent. LVEF measured by left ventriculography was higher compared with that by CMR, and their correlation was moderate (ICC=0.56). Conclusion: The LVEF measurement by a cardiovascular radiologist and a trained technologist using CMR was very reproducible, but the correlation between CMR and left ventriculography was moderate.

Importance of delayed perfusion with primary angioplasty on short-term mortality in acute myocardial infarction patients.

BACKGROUND: Early primary coronary interventions (PCI) in acute ST elevation myocardial infarction (STEMI) is associated with improved outcome and mortality rate but delayed reperfusion especially after 6 hours is still doubtful in terms of clinical benefits because most myocardial muscle are infarcted after 6 hours of onset of chest pain. OBJECTIVE: The aim of the present study was to compare the mortality rate of patients treated with PCI within 6 hours of symptom onset to those treated between 6 to 24 hours after the onset of STEMI. MATERIAL AND METHOD: The present study included consecutive patients from the data of the Fast Track Registry of King Chulalongkorn Hospital from June 1, 1999 to October 31, 2003 to compare the thirty-day mortality of patients treated with early or delayed PCI (0-6 hours vs. 6-24 hours after symptom of chest pain) for STEMI. RESULTS: Two hundred and sixteen patients who underwent PCI were enrolled. Male gender (82% vs. 64.9%, p = 0.03) and history of smoking (72.1% vs. 50%, p = 0.04) were predominant in the early treatment group (ETG) vs. the delayed treatment group (DTG). Mean age (60.5% vs. 61.03%, p = 0.11), diabetes (31.4% vs. 29.7%, p = 0.82), hypertension (64.0% vs. 54.1%, p = 0.20), dyslipidemia (58.1% vs. 60.8%, p = 0.73), and ejection fraction < 40% (22.8% vs. 32.0%, p = 0.625) were similar in both groups. There were no differences in angiographic finding and hospital management. Door to balloon and total delay time were 124.13 +/- 143.27 min and 407.94 +/- 268.183 min, respectively. The thirty-day mortality (9.01% vs. 12.76%, p = 0.379) and I year mortality (12.4% vs. 16 9%, p = 0.532) were not significantly determined by Log rank test in both groups. As for cardiogenic shock, ETG tended to have a lower thirty-day mortality than DTG but no statistically significant difference (12.5% vs. 50.0%, p = 0.0809). CONCLUSION: The delayed PCI up to 24 hours in STEMI does not increase short-term mortality at thirty days; therefore, it may still have benefit in STEMI patients. However it tended to have higher short-term mortality than early PCI especially in cardiogenic shock but showed no statistical significance.

Renal dysfunction as an independent predictor of total mortality after acute coronary syndrome: the Thai ACS Registry.

BACKGROUND: Renal insufficiency in the acute coronary syndrome (ACS) is associated with poor cardiac outcome. In Asian populations, there are no data available for these associations. MATERIAL AND METHOD: Data was from the Thai ACS registry, only a new case of ACS. Clinical characteristics, treatment strategies, in-hospital mortality and 1-year mortality were compared for patients with normal or mild renal dysfunction (estimated glomerular filtration rate [eGFR]> 60 ml/minute/1.73 m2, n = 809 [44.5%]), moderate renal dysfunction (eGFR 30-60 ml/minute/1.73 m2, n = 706 [38.9%]), and severe renal dysfunction (eGFR < 30 ml/minute/1.73 m2, n = 301 [16.6%]). RESULTS: Of the 1,816patients with mean follow-up 10.8 months, the mean age was 65 years, and 59.2 percent of the groups were male. Patients with severe renal dysfunction were significantly older, less likely to be male (45.2%, p < 0.001) and had a greater prevalence of diabetes (63.1%, p < 0.001) and hypertension (85.4%, p < 0.001). In-hospital and 1-year mortality were 13.5% and 22.5% respectively. According to discharge diagnosis, unadjusted hazard ratios for overall in-hospital mortality was statistically significant only in ST elevation MI subgroup, hazard ratio was 2.73 (95% CI, 1.72 to 4.34) and 6.27 (95% CI, 3.78 to 10.4) for moderate and severe renal dysfunction group, respectively. The risk of death for all types of ACS at 1-year follow up increased when eGFR decreased below 60 ml/minute/1.73 m2, the adjusted hazard ratio was 1.66 (95% CI,1.22 to 2.23) and 1.91 (95% CI, 1.34 to 2.72) for moderate and severe renal dysfunction group, respectively. CONCLUSION: From Thai ACS registry, renal dysfunction at presentation is an independent predictor for the overall 1-year mortality and appeared to associate with an increase in hospital mortality in the subsets with STEMI

Diabetes mellitus and non-ST elevation myocardial infarction in Thai ACS Registry.

OBJECTIVE: To describe differences in in-hospital morbidity and mortality, presenting characteristics and management practices of diabetic and non-diabetic patients with non-ST elevation myocardial infarction using data from Thai ACS registry. MATERIAL AND METHOD: Thai ACS registry is a multi-center prospective project of nationwide registration in Thailand. RESULTS: The present study consisted of 3,548 patients with non-ST elevation myocardial infarction from 17 hospitals in about a 3-year period. About 50% of the patients with diabetes were more often female, with a greater prevalence of hypertension and dyslipidemia. The diabetic group was at an increased risk for congestive heart failure (adjusted odds ratio 1.84) but not increased risk for cardiac arrhythmia, cardiac mortality, and in-hospital mortality. CONCLUSION: There was a very high prevalence of diabetes in non-ST elevation myocardial infarction from ThaiACS registry. These patients were at increased risk for congestive heart failure as index of hospitalization but were not at increased risk for in-hospital mortality when compared with patients without diabetes.

Predictors of in-hospital mortality in Thai STEMI patients: results from TACSR.

BACKGROUND: Clinical predictors of high-risk STEMI patients may guide physicians to the type of treatment, as high-risk patients need more aggressive treatment than low-risk patients. There was no previous registry of STEMI patients in Thailand. Objective: To determine the clinical predictors of in-hospital mortality in STEMI patients from the Thai ACS MATERIAL AND METHOD: A multi-center prospective nationwide Thai Acute Coronary Syndrome Registry (TACSR) was done between August 1, 2002 and October 31, 2005. The STEMI patients were registered to Thai ACS web site. Clinical and demographic characteristics, coronary risk factors, presenting symptoms, in-hospital treatments, reperfusion procedures and the patients' outcomes were recorded and analyzed. RESULTS: 3,836 STEMI patients were studied. The mean age was 62.2 +/- 12.8 years and 68% of the patients were male. The mortality rate of Thai STEMI patients was 17% (86.8% from cardiac causes) and the main cause of death was pumping failure (61.3%). The patients with older age > or = 75 years, patients with diabetes, shock, and cardiac arrhythmias had a higher mortality (29.4, 21.2, 43.4 and 37.24% respectively), while patients who underwent primary percutaneous coronary intervention (primary PCI) had a lower mortality rate (12.66%). Patients who received treatment with ASA, beta-blocker ACE inhibitor/ARB and statin had lower in-hospital mortality. CONCLUSION: The clinical predictors of high in-hospital mortality in STEMI patients from the TACSR were older age > or = 75 years, diabetes, shock, and cardiac arrhythmias. The treatments that can decrease the mortality were primary PCI, ASA, beta-blocker, ACE inhibitor/ARB and statin.

Demographic, management practices and in-hospital outcomes of Thai Acute Coronary Syndrome Registry (TACSR): the difference from the Western world.

BACKGROUND: To establish a national registration of acute coronary syndrome (ACS) registry in Thailand by networking health service institutions to determine the demographic, management practices, and in-hospital outcomes of patients with ACS. MATERIAL AND METHOD: The Thai ACS registry is a multi-center prospective project of nationwide registration in Thailand. Institutions were invited to participate in the registry through members of the Heart Association of Thailand. A series of workshops were organized to ensure standardization and quality control of the data and conduct of the present study. Web-based double data entry was used and the data were centrally managed and analyzed. RESULTS: The enrollment of the patients started in August 2002. After three years, records of 9,373 patients were collected from 17 hospitals. The patients were classified as ST elevation myocardial infarction (STEMI) (40.9.%), non-ST-elevation myocardial infarction (NSTEMI) (37.9%) and unstable angina (UA) (21.2%). The STEMI group was younger predominantly male, with a fewer number of diabetes than NSTEMI or UA. About half of the STEMI patients (52.6%) received reperfusion therapy. Primary percutaneous coronary intervention (PCI) was performed in 22.2% of STEMI. The median door to needle and door to balloon time were 85.0 and 122 minutes respectively. The median times to treatment were 240 minutes in the thrombolysis group and 359 minutes in the primary PCI group. Nearly half of NSTEMI and UA went to coronary angiography and about one-fourth of them received revascularization either PCI or coronary artery bypass grafting in the same admission. The total mortality rate was high in STEMI (17.0%) followed by NSTEMI (13.1%) and UA (3.0%). CONCLUSION: Thai ACS registry provides a detail of demographic, management practices, and in-hospital outcomes of patients with ACS. Time from onset to admission, door to needle time and door to balloon time were considered as suboptimal. Overall, in-hospital mortality is higher than reports from Western countries. The raising awareness among the general population about urgency of seeking medical attention for chest pain and concerted effect to improve in-hospital time delay is warranted. These data may have an impact on our health care system and alert the government to adopt an appropriate policy to solve these problems.

Detection of coronary stenoses in chronic stable angina by multi-detector CT coronary angiography.

OBJECTIVE: To assess the accuracy for detection of coronary stenoses in chronic stable angina patients. MATERIAL AND METHOD: Twenty-four chronic stable angina patients, referred for conventional coronary angiography by the indication of positive stress tests or clinical highly suspicion of coronary artery disease were enrolled. MDCT coronary angiography (MDCTCA) and conventional coronary angiography (144 coronary vessels) were performed within one month. Accuracy of MDCTCA for predicting significant coronary artery stenoses was analyzed. RESULTS: Five patients were excluded due to the total Agaston calcium score more than 500. Therefore, 114 vessels or 209 segments from 19 patients (9 males and 10 females) were available for analysis, and 186 segments were assessable (89%). Of all assessable segments, 13 from 20 significant lesions (65%) and 158 from 167 normal or non-significant lesions (95%) were correctly detected by MDCTCA. The sensitivity, specificity, positive and negative predictive values to detect significant coronary artery stenoses in terms of vessel are 82%, 96%, 79%, and 97% respectively. CONCLUSION: Coronary CT angiography provides accurate assessment of coronary luminal artery narrowing and shows the ability to exclude significant coronary artery stenoses in patients with chronic stable angina.

Reliability of the evaluation for left ventricular ejection fraction by ECG-gated multi-detector CT (MDCT): comparison with biplane cine left ventriculography.

OBJECTIVE: To evaluate the reliability of measurement for left ventricular ejection fraction (LVEF) by ECG-gated multi-detector CT (MDCT) comparing with biplane cine left ventriculography that is current gold standard. MATERIAL AND METHOD: The authors reviewed the data from 15 patients who were referred for coronary CT angiography for clinical indications and underwent cardiac catheterization within 14 days. Coronary CTA studies were performed on MDCT Somatom Sensation 16, Siemens, Germany, Slice thickness 1 mm, Slice collimation 0. 75 mm, and Pitch 0. 3. L VEF were measured with MDCTby Simpson s method and compared with values measured by biplane area length method from cardiac catheterization. The L VEF from both techniques were compared using intraclass correlation power analysis (SPSS analysis software). RESULTS: The study population consisted with six men and nine women with a mean age of 54+/-10 years. The LVEF measured from MDCT and cine ventriculography were 54.7 +/-10% and 56. 3+/-10%, respectively. LVEF measured with MDCT by interpreter I and interpreter 2 was significantly correlated with L VEF measured with biplane cine ventriculography (ICC= 0.99 and 0.98, respectively). The interobserver reliability was excellent with ICC = 0.9. CONCLUSION: LVEF measurement with MDCT during coronary CT angiography can be performed easily, very accurately, and compare well with measures taken from biplane cine left ventriculography.

Comparison of official hours versus non-official hours: percutaneous coronary intervention in acute ST-elevation myocardial infarction patients.

BACKGROUND: Percutaneous coronary intervention (PCI) is now a favorable treatment for acute ST elevation myocardial infarction (STEMI). However, in non-official hours (non-OH), this modality of treatment has a questionable outcome because of the treatment delay. OBJECTIVE: To compare the outcomes of PCI during official hours (OH) with non-OH in acute STEMI patients. MATERIAL AND METHOD: A prospective consecutive registry of PCI in acute ST-elevation MI patients at King Chulalongkorn Memorial Hospital from May 1999 to December 2003 were analyzed. Kaplan Meier survival analysis was used to determine the in-hospital mortality. Multivariate analysis was used to determine the prognostic factors for in-hospital mortality. RESULTS: Two hundred and fifty six consecutive patients (OH-107, non-OH-149) who underwent PCI for acute STEMI were enrolled. Their mean age (61.9 +/- 12.2 vs 60.6 +/- 12.8 y, p = ns), male gender (73.8% vs 73.2%, p = ns), history of diabetes (30.2% vs 33.8%, p = ns), severity of the patients (percent of patients in Killip IV--22.4 vs 21.5, p = ns), ejection fraction (48.7 +/- 15.1 vs 45.9 +/- 14.7, p = ns), cardiopulmonary resuscitation prior PCI (15.0% vs 14.2%, p = ns), anterior MI (55.1% vs 51.0%, p = ns) were similar in both groups. Hypertension was slightly less common (39.6% vs 52.7%, p = 0.04) but smoking was more common (62.6% vs 49.0%, p = 0.03) in OH group. Door to balloon time and decision to balloon time were significantly shorter in the OH group than the non-OH group (67.9 +/- 47 vs 119.6 +/- 83 min, p < 0.001 and 60.8 +/- 35 vs 98.3 min, p < 0.001). However, the total delayed time was not statistically significantly different (402 +/- 316 vs 424 +/- 215, p = 0.55). Angiographic success rate was achieved in 98.1% for the OH group and 94.7% in the non-OH group (p = ns). In-hospital mortality rate was 10.3% and 10.7% respectively. CONCLUSION: The door to balloon time for PCI in acute STEMI patients in the non-OH group was longer than the OH group; however, the total delayed time was not different. The in-hospital mortality rate was similar.

Feasibility and effectiveness of a novel vascular hemostatic device (Chula-clamp) after coronary angiography or percutaneous coronary intervention.

BACKGROUND: Chula-clamp is a newly hydraulic vascular hemostatic device. The advantages of the device are convenience, reusability, and lessen patient discomfort and vascular complication. Furthermore, the device is assembled with a recycled balloon inflator and other locally made components, which make it less expensive than other commercially available hemostatic devices. The present study was conducted to compare the effectiveness of Chula-clamp with standard manual compression. MATERIAL AND METHOD: This is a prospective, quasi-randomized controlled clinical trial comparing effectiveness of Chula-clamp to conventional manual compression for attaining femoral artery hemostasis after coronary angiography (CAG) or percutaneous coronary intervention (PCI). Effectiveness was determined by femoral vascular complications rate. The primary endpoint was severe femoral vascular complications (the formation of a groin hematoma, femoral artery thrombosis, pseudoaneurysm, and arteriovenous fistula). RESULTS: One hundred and forty patients scheduled for percutaneous coronary intervention or coronary angiogram in King Chulalongkorn Memorial hospital were enrolled (70 patients for each group). The baseline characteristics were similar in both groups. There was no serious vascular complication detected in either group. In addition, there was no statistical difference in minor complications at the access site between the two groups. [e.g., swelling (1.4% in standard manual compression group vs. 2.9% in Chula-clamp, p = 0.56) and ecchymosis (8.57% in both groups)]. CONCLUSION: Chula-clamp, a novel hydraulic vascular hemostatic device, is feasible, safe, and effective for femoral artery hemostasis (after CA G or PCI via femoral artery). Its effectiveness is not different from standard manual compression.

The difference among stress and rest normal reference databases using non-corrected, scatter corrected, and scatter with attenuation corrected Bull's eye myocardial perfusion scintigraphy in both genders.

OBJECTIVES: To compare 3 types of Bull's eye normal reference maps; non-corrected, scatter corrected, and scatter with attenuation corrected Bull's eye in both genders. MATERIAL AND METHOD: Sixty-seven normal healthy males and females volunteered for the present study. After screening tests to identify low post-test (exercise EKG) likelihood of coronary artery disease, 41 subjects (20 males and 21 females) had stress and rest myocardial perfusion scintigraphy (99mTc-sestamibi). The data were reconstructed by filtered back projection reconstruction in three ways as follows; (1) non-correction (NoC), (2) scatter elimination only (SC), (3) scatter elimination and attenuation correction (SC+AC). Three sets of reconstructed data of both stress and resting studies were added into 6 sets of Bull's eye. The data of each Bull's eve were normalized to 100% of the maximum count. Percentage of uptake in each area was compared by t-test statistics. RESULTS: Stress and rest count distribution of NoC and SC sets were lowest at the inferior wall, followed by the septal wall, anterior wall, and lateral wall in both genders. In the SC+AC sets; septum and lateral walls showed more uptake than anterior and inferior walls. A significant difference of percentage uptake between stress and rest images at septum in NoC and SC images in male and in SC image in female was observed. No difference was seen in the SC+AC groups. CONCLUSION: There was similarity of count distribution between NoC and SC images. SC+AC caused more uniform image. However; some non-uniformity was observed. The use of sex-independent SC+AC bull's eye is possible. Stress study can be omitted for bull's eye collection of normal files.

Percutaneous carotid stenting: a novel treatment for carotid artery stenosis.

BACKGROUND: Stroke is currently a leading cause of physical disability and carries a high mortality rate. About 20% of ischemic stroke is caused by carotid artery stenosis. Carotid stenting is now another therapeutic modality for the treatment of extracranial carotid artery stenosis. MATERIAL AND METHOD: All patients who underwent carotid stenting at King Chulalongkorn Memorial Hospital from March 2001 to December 2002 were analyzed. The case success was determined by residual angiographic stenosis of less than 30% without any major adverse cardiovascular events such as death, stroke or emergency re-intervention. RESULTS: Carotid stenting was performed in 6 patients with 9 vessels disease. Their mean age was 71.8 years. Hypertension was the most common risk factor detected in all patients, followed by smoking (83.3%), dyslipidemia (83.3%) and diabetes (33.3%). One third of the patients had a prior history of stroke or transient ischemic attack and 16.6% occurred within 6 months. Five of six (83.3%) had severe coronary disease and required coronary artery bypass grafting after successful carotid stenting. The procedures were successful in all patients. The average percent of stenosis was reduced from 83.2% to 9.4%. The distal protection device was used in one-third of the cases. The average procedure time was 63.6 minutes and fluoroscopic time was 16.6 minutes. There was no evidence of stroke or death after the procedures. Only one (11.1%) developed hypotension and bradycardia that required intravenous fluid loading and inotropic support for 24 hours. CONCLUSION: Carotid stenting at our center is feasible and considered to be a safe procedure for the treatment of carotid artery stenosis. This procedure is another alternative treatment and may be superior to carotid endarterectomy, the standard treatment of carotid artery stenosis.

Worse prognosis for women who underwent primary percutaneous coronary intervention for acute ST-elevation myocardial infarction.

BACKGROUND: Many reports have shown that female gender carries a worse prognosis when developing acute myocardial infarction (MI), whether or not reperfusion therapy is used. The primary percutaneous coronary intervention (1-PCI) is currently a preferable treatment for acute ST-elevation MI. However, the data concerning the difference between the outcomes in the treatment of the disease in men and women in Thailand is still insufficient. MATERIAL AND METHOD: A prospective registry of acute ST-elevation MI patients who underwent 1-PCI at King Chulalongkorn Memorial Hospital from June 1999 to December 2002 were analyzed. Kaplan Meier survival analysis is used to determine the in-hospital mortality. RESULTS: The consecutive 184 (F-52, M-131) patients who underwent 1-PCI were recruited. Female subjects were older (66.6 +/- 12 y versus 59.0 +/- 11.6 y, p < 0.01); they also had higher percentage of diabetes (45.1 versus 27.1, p < 0.01), but a fewer number of smoker (17.7 versus 66.2, p < 0.001). The percentage of patients who had cardiogenic shock tended to be higher in women (34.6 versus 19.9, p = 0.08); however, the number of anterior wall MI and ejection fraction were not different. The mean door to balloon time (109 +/- 95 versus 99 +/- 68 minutes) and pain to balloon time (454 +/- 271 versus 372 +/- 298 minutes) were not different in both groups. The angiographic success with TIMI 3 flow was achieved in 92.3% for females and 86.9% for the males. The in-hospital mortality was significantly higher in females (23.1 versus 6.1, p = 0.002). Univariate analyses demonstrated that the feminine gender, cardiogenic shock, smoking, ejection fraction less than 40, cardiac arrest prior PCI and angiographic were the predictors for in-hospital mortality. When using multivariate analyses by Cox proportional model, only cardiogenic shock, history of hypertension and angiographic success were the significant predictors. Women had 2.15 times of in-hospital mortality higher than males; however, the confidence interval cross-over 1 (0.74-6.42) and p value was 0.16. CONCLUSION: Females tend to have a poor prognosis when they develop acute ST-elevation MI which requires treatment with 1-PCI.

Bilateral carotid stenting prior to coronary artery bypass graft: a case report.

BACKGROUND: Carotid stenosis is an independent possible complication of the central nervous system of patients after receiving a coronary artery bypass graft (CABG). The risk increases when the patient has bilateral carotid stenosis even if asymptomatic. CASE REPORT: A 76 year-old female was admitted because of unstable angina. The coronary angiography showed triple vessel disease and required CABG for revascularization. Her physical examination revealed bilateral carotid bruits. She did not have any history of neurological deficit. Carotid Doppler showed critical stenosis of bilateral carotid arteries. The carotid angiography demonstrated 70 per cent diameter stenosis of both internal carotid arteries just above the bifurcation of the external carotid artery. A 7 x 20 mm self-expandable Smart stent was implanted first in the right carotid artery with good angiographic result. Five days later, another 7 x 20 mm self-expandable Smart stent was implanted in the left carotid artery without residual stenosis. The patient did not have any cardiovascular complications. CABG was performed 2 weeks later with a good result. The patient was discharged 10 days after CABG. CONCLUSION: Bilateral carotid stenting is feasible and produces an acceptable outcome. This procedure is an alternative treatment for preventing stroke during CABG surgery.

Initial and long-term results of coronary angioplasty: a report from King Chulalongkorn Memorial Hospital.

PTCA is one of the treatments for coronary heart disease. But in Thailand, there is no available data on the long-term outcomes of patients who have undergone this procedure. To determine initial and long-term outcomes of patients who underwent percutaneous transluminal coronary angioplasty (PTCA), patients who underwent PTCA from January 1996 to December 1997 were enrolled. The initial results were received from the PTCA registry. The follow-up data were collected from medical records, phone calls and mail. Three hundred and forty patients (male 68.8%) were enrolled. Mean age was 61.8 +/- 10.1 years. Dyslipidemia was the most common risk factor (50.3%), followed by hypertension (44.4%), smoking (40%), and diabetes (33.8%). Indications for PTCA were chronic stable angina (47.9%), unstable angina (22.1%), acute myocardial infarction (4.3%) and post myocardial infarction angina (25.8%). Diseased vessels were left anterior descending (44.8%), right coronary artery (28.0%), left circumflex artery (25.5%), left main artery (0.9%) and saphenous vein grafts (0.8%). Initial case success rate was 93.5 per cent. Stent was implanted in 41.8 per cent of cases. In-hospital mortality rate was 1.2 per cent. Two patients (0.6%) developed Q-wave myocardial infarction (MI). Four patients (1.2%) required emergency bypass surgery (CABG). Major adverse cardiac events occurred in 6 patients (1.8%). Two hundred ninety one patients (85%) had complete follow-up data, mean follow-up time was 990 +/- 326 days. Twenty-one patients died (6.4%) but only 12 (3.5%) were cardiac in origin. Other cardiovascular events were non-fatal MI (1.2%), unstable angina (10.7%), congestive heart failure (4.6%), and chronic stable angina (41.1%). Target lesion revascularization by PTCA was done in 55 patients (16.9%) and CABG was performed in 22 patients (6.7%) Conclusion: PTCA can be performed with a high success rate and low in-hospital complications. Long-term outcomes are acceptable and comparable with Western data.