ABSTRACT
Background: The patient with inferior wall AMI, site of culprit lesions is an important determinant of outcome. Patient with RV infarction have a poor prognosis whereas those with occlusion of LCX have a good prognosis. Early diagnosis and treatment substantially reduce cardiac events particularly in high-risk patients. V4R can be used as to locate the site of obstruction. Materials and methods: 81 patients with acute inferior myocardial infarction admitted to the coronary care unit (CCU) within 12 hours after the onset of chest pain who underwent coronary angiogram were included in the study. Standard 12-lead ECG with right precordial lead V4R was recorded. Patients were categorized into within 3 groups according to early changes of V4R-Group- I - ST-segment elevation > 1 mm and positive T- wave, Group-II- ST-segment iso-electric and positive T-wave, Group-III- ST-segment depression >1 mm and negative T -wave. Results: In group I patients, highest percentage of the patients had lesion in proximal RCA (97.2%); whereas in group II patients, highest percentage in the distal RCA (89.7%) followed by LCX (41.4%) and in group III patients, highest percentage also in LCX (100.0%) followed by LAD (56.3%). Based on analysis of sensitivity and specificity, it was revealed that in group I patients of ECG finding suggested 100.0% sensitivity, 97.8% specificity and 98.8% accuracy. In group II patients, 92.9% sensitivity, 94.3% specificity and 93.8% had accuracy. In case of group III patients, 93.8% sensitivity, 98.5% specificity and 97.5% accuracy. Conclusion: The configuration of the ST-T segment in lead V4R is a sensitive and specific tool to recognize the occluded vessel in acute inferior MI whether it is proximal RCA, distal RCA or LCX. Since it is an inexpensive method, it can be readily used to locate the site of occlusion in AMI - Inferior.
ABSTRACT
Background:To accurately stratify patients undergoing PCI, according to their risk of future adverse events, a quest for risk predictors is ongoing worldwide. But only a few powerful and independent predictors of early and late major adverse cardiovascular events have been found. These include traditional risk factors, such as acute coronary instability, diabetes mellitus, reference vessel diameter, and lesion and/or stent length. This study was undertaken to find out the relationship between pre-procedural CRP level with in-hospital (both procedural and before discharge) complications. Materials & methods: This prospective study was carried out in National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period of June,2006 to May,2007. After fulfilling the exclusion criteria, 100 consecutive patients were selected as sample those underwent percutaneous coronary intervention. C-Reactive protein (CRP) was measured in all patients before the procedure. Those having pre-procedural CRP level <.3 mg/dl was labeled as group-I and those with CRP level e”.3 mg/dl was labeled as group-II. In hospital outcomes were compared between two groups after percutaneous coronary intervention. Results: During the procedure, higher rate of complications (10.0% vs 26.0%) were noted in group- II, which was statistically significant. Among many complications abrupt occlusion, threatened (dissection and new thrombus) and residual stenosis were significantly high in group-II. Other complications like coronary spasm, arrhythmia, side branch occlusion, heart failure, shock and no reflow were also high in higher level of CRP level patients but statistically not significant. Inhospital complications were also significantly high (10.0% vs 28.0%) in patients with higher level of CRP ie. Group-II. Among other complications recurrence of ischemia and myocardial infarction developed at significantly higher rate in group-II. Post procedural CK-MB rose significantly (18.0% vs 36.0%) in patients with higher level of CRP (group-II) in comparison to normal level of CRP patients (group-I). When the in-hospital complications were distributed among three tertiles of CRP, it was observed that complications were proportionately high with increasing level of CRP. Conclusions: Many studies, conducted abroad, have suggested that factors like gender, extreme age, diabetes, multi-vessel disease and lesion characteristics adversely influence PCI outcome. But in this study, multivariate regression analysis has shown that elevated level of CRP is even stronger independent predictor of PCI outcome.