Procedural determinants of fluoroscopy time in patients undergoing cardiac catheterization

Background and Objective: Due to increase in number of cardiac catheterization procedures safety concerns is an issue nowadays. Multiple diagnostic modalities use radiations, which also put a patient at higher cumulative radiation exposure. Therefore steps should be taken to minimize radiation exposure during cardiac catheterization. Hence determination of factors which prolong FT will result in better understanding of problem.This retrospective study was undertaken to determine factors responsible for prolong fluoroscopy time in patients undergoing coronary artery catheterization

Methods: This retrospective study was conducted at catheterization Laboratory National Institute of Cardiovascular Diseases, Karachi from June 2014 to June 2015. Patients of either gender, aged between 18 to 90 years undergoing cardiac catheterization procedures were included. Radiation exposure time was measured in terms of fluoroscopy time

Results: A total of 957 patients were included in this study out of which 731 were of diagnostic Coronary Angiograms [CA] and 226 were of Percutaneous Coronary Intervention [PCI]. The mean age of the study participants was 54.12+/-10.89 years and majority 734[76.6%] were male. Mean fluoroscopy time [FT] in the patients subjected to PCI was 9.61+/-6.07 minutes while in cases for CA 4.17+/-4.13 minutes. FT for CA was observed significantly dependent on procedural access, operator's experience, and LV angiogram. While FT for PCI was found dependent on number of stents deployed during the procedure

Conclusion: For invasive coronary angiographic procedures radial route increased fluoroscopy time. For percutaneous coronary intervention femoral and radial route fluoroscopy time were not significantly different

Outcome of primary percutaneous coronary intervention [PCI] of ostial versus nonostial occlusion of left anterior descending artery [Study conducted at National Institute of Cardiovascular Diseases, Karachi]

Object: The object of this study was to compare the outcome of primary PCI of ostial versus non ostial occlusion of LAD artery

Materials and Methods: This observational study was conducted at National Institute of Cardivascular Diseases Karachi, Pakistan from January 1[st], 2008 to December 31[st], 2008. A total of 70 patients presented to the catheterization laboratory for primary PCI of LAD artery in whom baseline coronary angiogram showed acute occlusion of left anterior descending artery were enrolled for the study. All patients received Aspirin, Clopidogrel and Platelet Glycoprotein IIB IIIA inhibitor. Patients were followed at one month, 3 months and 6 months

Results: Out of 70 cases 50 had nonostial and 20 had ostial occlusion. Baseline characteristics were similar between both groups. Stenting was done in 95% of all patients and was similar in patients with ostial or nonostial narrowing. Procedural success was the same for ostial and nonostial Primary PCI [100% vs. 96%]. Six months event free survival was also similar in both groups [75% vs. 76%]. Total event rate and mortality was also same in both groups [25% vs. 24% and 10% vs. 10%]

Conclusion: Primary PCI of ostial LAD occlusion with suitable anatomy is as safe and similar as non ostial LAD occlusion and optimal results can be achieved in this high risk group of patients in a developing country at a tertiary care public sector hospital. To validate our results further studies with larger cohort are needed

impact of age and sex in the pattern of coronary artery disease

Coronary Artery Disease [CAD] is the primary cause of death in the world. Over the last three decades, invasive procedures such as coronary artery bypass grafting [CABG] and percutaneous coronary interventions [PCI] have resulted in significant improvements in survival and quality of life for patients. Besides traditional modifiable risk factors, it has been proved that some fixed, nonmodifiable factors contribute in the behaviour of coronary involvement. To see whether the age and sex as a coronary risk factor contribute this differential coronary involvement, we conducted this study. To determine the frequency of coronary artery disease [CAD] as it varies with age and gender. It is a descriptive study carried out at NICVD Karachi. All the subjects were adults with previous history of ischemic heart disease and recommended coronary angiography based on history and non-invasive tests. There were 79.6% male patients and the mean age was 52 years [ranged from 28 to 85 year]. In 80% of patient femoral artery access was used for performing the procedure. Right coronary artery was found dominant in 73% angiograms. Left anterior descending artery was the most frequently involved artery[73.6%] among major coronary arteries and obtuse marginal was most frequently involved [20.4%] branche artery. Ramus intermedius was found diseased in 4.2%.The frequency of involvement of Left Main artery and distal segments of major coronary arteries was increased with advancing age but there was no significant association between age and sex and involvement of other coronary arteries. In conclusion males have a higher recorded rate of coronary angiography and single vessel disease is the most common finding. Females and ages above 80 and below 40 had low incidence of angiographic events

Determinants of decrease in pulmonary hypertension following percutaneous mitral commissurotomy

To identify the determinants of decrease in pulmonary hypertension after percutaneous balloon mitral commissurotomy. Quasi experimental study. Place and Duration of Study: National Institute of Cardiovascular Diseases, Karachi, from March to October 2007. Adult patients with severe mitral stenosis and pliable valve having no significant mitral regurgitation, aortic valve disease, or left atrial thrombus were selected for Percutaneous Transvenous Mitral Commissurotomy [PTMC] by double balloon method. All patients underwent echocardiography of left and right heart catheterization before and after PTMC. Univariate and multivariate analysis was done to assess the relation of age, gender, left atrial size, right ventricular size, gradient across mitral valve, valve area, valve area per meter,2 body surface area, and presence of Tricuspid Regurgitation [TR] on the decrease in pulmonary arterial pressure. Of the 100 cases included in the final analysis, 60% were female, 84% were in sinus rhythm and had a mean age of 27 years. There was a 48% decrease in mean left atrial and 29% decrease in right ventricular systolic pressure immediately postprocedure. The mitral valve area increased from 0.883 +/- 0.1261 cm2, pre-ballooning to 1.7864 +/- 0.28445 cm2 post-PTMC, a percent change of 102.41%. In multivariate analysis, mean left atrial pressure [p=0.00: CI=0.317- 0.007], younger age [p=0.010: CI=-0.667 to -0.095] and right ventricular size [p=0.038: CI: 0.25-0.871] were independent predictors of decrease in systolic pulmonary arterial pressure post-PTMC. Younger age, mean and left atrial pressure and right ventricular size were independent predictors of decrease in pulmonary systolic pressure immediately post-PTMC

Gender differences in presentation of acute myocardial infarction

The purpose of this study was to determine the gender differences in the Presentation of Acute Myocardial Infarction. Observational study. National Institute of Cardiovascular Diseases - Karachi, study was carried outfrom 1st Sept. 2006 to 31st December 2006. Consecutive 1008 patients were included in this study with definite evidence of first episode of AMI. There were 758 [75.1%] men and 250 [24.8%] women. Women were on average 7 years older than the men [58 vs 51 years, p=<0.01]. 13% of female patients were menstruating while 87% were non-menstruating. 9.3% of our patients were under the age of 40 years. 13% of women and 9% of men were obese. Women more frequently had hypertension [67% vs 37%, p=<0.001], DM [38% vs 22%, p=<0.001]. More of the men were cigarette smokers [60% vs 8%, p = <0.001]. Women had more in-hospital complications [38% vs 25%, p= <0.01], and mortality [13.4% vs 5.5%, p = <0.001]. Women were less likely than men to be eligible for thrombolytic therapy [54% vs 77%]. These results indicates that women were 6 years older than men presented with AMI and more likely to have hypertension, DM and Pre-infarction angina. The in-hospital complication and mortality were higher in female patients than male. Less women were elegible for thrombolytic therapy on arrival compared to men

Coronary angiographic characteristics of coronary artery disease in young adults under age forty years compare to those overage forty

To compare the coronary angiographic characteristics of coronary artery disease in young patients of less than and equal to 40 years of age with those of more than 40 years of age. Observational study conducted from Sept to Jan 2003-2004. A total of 299 patients of Coronary Artery Disease were included in the study. 102 patients were in less than and equal to 40 years of age [group 1] and 197 patients were in greater than 40 years of age [group II]. All patients were selected according to inclusion and exclusion criteria. All demographic and clinical variables and laboratory investigations were recorded for each patient. Coronary angiographic characteristics were recorded and analyzed for each group. Study result showed that more patients in group I had single vessel disease than patients in group II 39% vs 15% respectively, which was statistically significant P=0.001, while patients in group II had more double, triple and LM disease as compared to group I 35% vs 20% [P=0.04], 25% vs 12% [P=0.03] and 9% vs2% [P=0.03] respectively. There was statistically no significant difference between the groups in terms of baseline demographic and clinical variables except for angina class and DM. Group I had more angina class-I patients 51% vs 25% than group II [P=0.003], while group II had more patients with DM 36% vs 14% than in group I [P=0.002]. There was no difference between the groups in terms of length of lesions and types of lesions determined by coronary angiography and predilection for invovment. The most common effected vessel was LAD followed by RCA and CX. It is evident from present study that young patients of CAD have less extensive disease. CAD in young person is more prevalent in those who smoke and had deranged lipid profile

Transradial diagnostic and percutaneous coronary intervention

To describe the technique and rationale of coronary diagnostic and intervention procedures via radial artery. Design: A descriptive study. Place and Duration of Study: From January, 2000 to August, 2001 at National Institute of Cardiovascular Diseases [NICVD], Karachi. Subjects and A total of 167 [3.6%] patients underwent TR approach for both diagnostic and intervention procedures. The minimum age of the patients was 20 years whereas maximum age was 75 years. All patients with positive Allen's Test were included in the study. All the procedures were done by using the right radial artery approach. Out of 167 cases 76% were diagnostic and 24% were in Percutaneous Coronary Intervention [PCI] group. In 3% the radial artery approach was not successful. In PCI group disease, pattern was single vessel [58%] with mostly left anterior descending artery[LAD] involvement [44%]. Lesions were mostly low to moderate risk. In PCI group 51 stents both pre-mounted and un-mounted [bare] were used. In 19% cases, direct stenting was done while 12.5% patients received Abciximab and 7.5% patients underwent IVUS for lesion quantification. In PCI group, procedure was unsuccesful in 2.4% cases due to inability to cannulate and negotiate the lesion. In our limited local experience of 167 cases of TR approach, there were no major complications like major bleed, limb ischemia etc. The TR approach for invasive procedures yields comparable results to femoral approach. It has a major benefit of reduction in puncture site related complications vis-a-vis intensive use of anticoagulants, antiplatelet, and fibrinolytics required for PCI. Additionally, the approach also increases patient comfort through early mobilization and reduction in cost