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: The relationship between metabolic syndrome score and coronary artery disease severity is unclear in the presence of diabetes. Hypothesis: The hypothesis of this study is to assess whether there is a relationship between metabolic syndrome score and coronary artery disease angiographic severity and whether or not the severity of the relationship differs in the presence of diabetes. Methods: We consecutively enrolled 132 metabolic syndrome patients who underwent their first coronary angiography. We used four angiographic scores and compared the relationship between metabolic syndrome score and angiographic coronary artery disease severity or clinical presentation between diabetic and non-diabetic subjects. Results: Individuals with both metabolic syndrome and diabetes (n=64) had significantly higher metabolic syndrome scores, acute coronary syndromes, double and triple vessel disease, higher coronary score, extent score, severity score, and atherosclerotic score than metabolic syndrome patients without diabetes (n=68). A significant correlation was apparent between metabolic syndrome and coronary atherosclerotic scores in patients without diabetes. In contrast, we did not observe any significant correlation between metabolic syndrome score and coronary atherosclerotic scores in patients with diabetes. Multivariate regression analysis revealed that metabolic syndrome score is an independent predictor of atherosclerotic score in non-diabetics. Conclusion: While the relationship between metabolic syndrome score and angiographic coronary artery disease severity was disguised by the presence of diabetes, the metabolic syndrome score was related to the extent of coronary atherosclerosis in Indian patients without diabetes. Calculating the metabolic syndrome score might provide additional information for predicting the extent of coronary artery disease in patients with angina without diabetes.
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”.
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PURPOSE: To ascertain the relationship between seropositivity to chronic infections with Helicobacter pylori, Chlamydia pneumoniae and Cytomegalovirus (CMV) and acute coronary syndromes and association of each of these infective agent with biochemical parameters and cardiovascular risk factors. METHODS: The present study was a case-control study involving 117 patients [unstable angina (UA) n=101 and chronic stable angina (CSA) n = 16] attending cardiology clinic. The cases were aged 35-79 years and they were compared with age, sex and socio-economic status matched controls without evidence of coronary artery disease (CAD). RESULTS: Fifty seven (58%) patients with UA and 9(56%) patients with CSA were seropositive for H. pylori. Sixty seven (66%) subjects with UA and 15(94%) patients with CSA subjects were seropositive for C.pneumoniae. Two (2%) patients with USA were seropositive for Cytomegalovirus (CMV). Seropositivity in normal subjects for H. pylori, C. pneumoniae and CMV was 7(43.25%), 10(62.5%) and 1(6.25%) respectively. In linear regression analysis seropositivity of CMV showed positive association with HDL-C (P< 0.05). No significant association of infective agents and coronary syndromes was observed. CONCLUSIONS: Higher levels of lipids, lipoproteins, C-reactive protein and higher percentage of coronary risk factors in patients seropositive for H. pylori in UA suggests the role of infective agents in pathogenesis of atherosclerosis.