ABSTRACT
Background: The presence of ischemic ECG changes on admission has been shown to predict outcome, the relationship between the extent of ECG changes and the risk of cardiac events is still ill defined. The severity of ST-segment depression on admission ECG has a strong association with adverse in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome. The study was done to observe the extent of ST-segment depression and in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome. Methods: This study was conducted in the Department of Cardiology in NICVD Dhaka, from January 2006 to December 2007. Considering inclusion and exclusion criteria, a total of 183 patients were evaluated. All the patients were evaluated clinically after admission. ECG, blood biochemistry and echocardiography were done. Patients were categorized into three groups according to the extent of ST- segment depression. Results: In this study, analysis of the baseline parameters revealed no statistically significant difference among the three groups of patients (p>0.05). Mean sum of the ST-segment depression analysis was done and all mean values were more in group III patients. 41.0% patients developed complications during the study period. Acute LVF (22.9%) was the most common complication followed by arrhythmia (11.5%), cardiogenic shock (4.4%) and STEMI (2.2%). All the complications were more in group III patients. During this period 6% patients died and more death (12.3%) was observed in group III patients. Conclusion: The amount of ST-segment depression is a powerful predictor of adverse in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome.
ABSTRACT
Background: Contrast-Induced Nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. The aim of this study was to assess whether anaemia is a predictor of contrast induced nephropathy after Percutaneous Coronary Intervention (PCI). Methods: This was a prospective observational study. A total of one hundred patients fulfilling the inclusion and exclusion criteria who underwent (PCI) Percutaneous Transluminal Coronary Angioplasty with stenting, were studied during the study period of two years from January 2008 to December 2009. Patients were divided into two groups : Group-I (n=50), patients with low hemoglobin (male <13-10gm/dl, female < 12-10 gm/dl) and Group-II (n=50), patients with normal hemoglobin (male >13gm/dl, female >12gm/dl). Non-ionic low-osmolar contrast agents was used in all patients.Volume of contrast medium (ml) was recorded. Adequate hydration given intravenously (ml). Prior to procedure serum creatinine, serum electrolytes and Creatinine clearance rate were measured within 24 hrs before PCI and on days 1,2,3 after PCI. If there is renal impairment (CIN) serum creatinine, serum electrolytes and Creatinine clearance rate were measured daily from the 4th day onward after PCI until recovery. Results: The mean serum creatinine level of low hemoglobin group and normal hemoglobin group were 0.9mg/dl and 1mg/dl respectively at base line. The low hemoglobin group experienced a considerable increase in serum creatinine up to 1.5mg/dl at day 3 compared to 1.3 mg/dl in normal hemoglobin group. When the most common definition of contrast induced nephropathy (as an increase in the serum creatinine concentration >0.5 mg/dl from baseline) was used the incidence of CIN was 26% in low hemoglobin group and 8% in the normal hemoglobin group. Conclusion: preprocedural low hemoglobin is an independent determinant of increased incidence of contrast induced nephropathy after percutaneous coronary intervention.