Short term clinical outcomes of Everolimus-eluting stents in patients with stable angina pectoris

Background and Objective: Everolimus-eluting stents, compared with bare metal stents, reduced the risk of restenosis in clinical trials with strict inclusion and exclusion criteria. The objective of this study was to determine the three months clinical outcomes of Everolimus Eluting Stents in patients with stable angina pectoris in Pakistani population

Methods: It was a descriptive cross-sectional study and the data was collected from Catheterization Laboratory Cardiology Department Lady Readings Hospital Peshawar. Our study included all the patients with stable coronary artery disease who had received Everolimus eluting stents from August, 2013 to April, 2014. Total study duration was 09 months. The primary end points were the rate of target vessel revascularization, myocardial infarction at three months. All those patients who received Everolimus coronary stents were recalled after three months from the index procedure and enquired about target vessel revascularization [TVR], myocardial infarction and hospitalization over the last three months. Data analysis was done using SPSS version 16

Results: Our study included 378 patients with stable ischemic heart disease who underwent revascularization with Everolimus eluting stent.These patients were followed up for a period of 3 months for target vessel revascularization [TVR] and myocardial infarction [MI]. Mean age was 57.04+/-9.307, males were [72%]. Left Anterior Descending [LAD] and Left circumflex [LCx] were the predominant vessels vascularized. Mean length of Everolimus eluting stent was 21.91+/- 4.6 while mean diameter of stent was 2.90+/-0.248. Thirteen [3.4%] patients had TVR and 14 [3.7%] patients had MI during three months follow up after PCI. TVR and MI were prevalent in patients who received longer Everolimus stents as compared to those who received shorter stents at three months, and the difference between the two was statistically significant

Conclusion: Short-term results from this study suggest that real-world outcomes among 378 patients are comparable to those reported in other registries and trials, and safety outcomes as measured by rates of TVR, MI were low. The long-term safety of Everolimus-eluting stents needs to be ascertained in large, randomized trials

Nonfasting Apo-lipoprotein B and triglyceride levels as a predictor of coronary heart disease in type II diabetic patients

Background and Objectives: Lipoprotein-A has been recognized as a risk factor for ischemic heart diseases. Myocardial infarction [MI] is common complication of ischemic heart disease. Diabetes play an incremental role in the development of coronary artery disease [CAD], however still there are conflicting data regarding the relationship of Lipoprotein-B and MI. We therefore wanted to evaluate the relationship of Lipo-B, MI and diabetes mellitus. Our objective was to determine the non-fasting Apo-lipoprotein B and triglycerides level among type II diabetic patients with ischemic heart disease and to compare with type II diabetic without ischemic heart disease

Methods: This was cross sectional study where two groups of patients were recruited in the study, Group-I included patient with Ischemic Heart Disease and diabetes while Group-II comprised of diabetes without Ischemic Heart Disease. Age, sex and basic demographic matching was done between the two groups. Data were collected using random sample. The comparative approach was used to see the role of diabetes in the elevation of Apo-lipoprotein B level, which is a risk factor for Ischemic heart diseases

Results: Two hundred forty eight patients [Cases: 123 Diabetic with myocardial infarction and [Control: 125 Diabetic without myocardial infarction] were included in the study. Mean Apo-B among diabetic patients with myocardial infarction was high [68.3+/-24.23 ng/ml] compared to non-cardiac patients [49.97+/-33.880 ng/ml] with a p <0.000. Marked difference was also observed in triglycerides levels where it was found very high [301.4+/-55.1 mg/dL] in patients of diabetes with myocardial infarction as compared to subjects without MI [137.7+/-84.7 mg/dL]. There was positive correlation between Apo-lipoprotein and Triglycerides [P value=039]

Conclusion: Based on the study result it was concluded that Apo-lipoprotein and triglycerides in diabetic patients with myocardial infarction, had higher levels compared to diabetic patients without Myocardial infarction and this could be a consequence of increase in age, insulin resistance and deficiency of insulin in the body. We also found positive correlation between Apolipoprotein and Triglycerides

Impact of stent length and diameter on short term clinical outcomes of drug eluting stents in patients with stable coronary artery disease

Background and Objective: The risk of restenosis and other adverse cardiovascular events with bare-metal stents have increased with smaller stent diameters and longer stent lengths. However, the exact impact of stent size on the short-term outcomes of drug-eluting stent [DES] implantations has not been much classified in Pakistani population. This study was designed to evaluate the impact of size [length and diameter] of Drug Eluting Stents on Clinical outcomes in patient with stable coronary artery disease at three months of implantation in Pakistani Population

Methods: This is a prospective study which was carried out in the Department of Cardiology, Lady Reading Hospital Peshawar from April 2011 and July 2012. All consecutive patients with stable coronary disease undergoing Percutaneous Intervention [PCI] with DES implantation at Cardiology Unit Lady Reading Hospital, were included prospectively. Clinical outcomes [Myocardial infarction [Ml], unstable angina[UA], and positive ETT] at three months stratified by 3 tertiles of stent length and diameter each, were measured in patients who underwent PCI with DES for coronary artery lesions. All patients were followed and reassessed after three months from the index procedure. Exercise Tolerance Test [ETT] was performed on every patient and recorded on proforma. Data analysis was done using SPSS software version 16

Results: A total of 376 patients were included prospectively in this study

The mean age was 57+/-9.313 years. Male patients were 271[72.1%]. Mean length of drug eluting stent was 27.313+/-7.235 mm while mean diameter of stent was 2.90+/-0.2483mm. There were slightly higher rates of Ml, U.A and positive ETT in the longest stent length tertile [>28mm] compared with the shortest stent length tertile [<22mm] at three months, but they were statistically not significant. We also observed that for DES, there was no clear relationship between stent diameter and outcome for any of the clinical outcome variables

Conclusion: In our single-center prospective study, stent length and diameter defined in tertiles, had no impact on the short-term clinical outcomes of DES in patients with stable coronary artery disease

Frequancy of hyponatremia and in hospital clinical outcomes in these patients hospitalized for heart failure

To determine the frequency of hyponatremia and in-hospital clinical outcomes in hyponatremic patients hospitalized for heart failure.This was a descriptive study conducted in department of cardiology, Lady Reading Hospital, Peshawar. Both male and female patients aged 14 years and above admitted with heart failure fulfilling the inclusion criteria, were included in the study. Patients were subjected to detailed history and clinical examination. Admission Serum sodium was measured in all patients. All the patients were managed according to guidelines. All patients were followed for in hospital mortality and length of hospital stay [LOHS].The total number of patients was 241. Mean age was 59.2 +/- 14.9 [range 18-100] years. Females were 123 [51%] patients. Mean serum sodium was 136 +/- 5.1mmol/L. Hyponatremia [serum sodium

Comparative analysis of type of myocardial infarction in patients with successful or unsuccessful streptokinase thrombolysis following st elevation myocardial infarction

To study the effect of thrombolytic therapy in term of success and failure on the type of ST elevation MI, using streptokinase. This was a comparative study, conducted at Department of Cardiology, Lady Reading Hospital, Peshawar, from October 2006 to October 2007. Patients with first acute myocardial infarction were divided into group A [successful thrombolysis] and group B [unsuccessful thrombolysis] using ECG criteria. Total number of patients were 200. Group A included 136 [68%] patients and group B included 64 [32%] patients. There were total 88 [44%] patients of anterior MI with 47 patients in group A and 41 patients in group B [34.6% vs 64.0%, p<0.001]. There were total 110 [55.0%] patients of inferior MI with 88 patients in group A and 22 patients in group B [64.7% vs 34.4%, p<0.001]. Lateral myocardial infarction was diagnosed in 2 [1%] patients with 1 patient each in group A and group B [0.7% vs 1.6%, p=0.583]. Anterior MI was associated with a higher rate of thromblysis failure while inferior MI and lateral wall MI was associated with a higher rate of successful thrombolysis.

Changing trend of presentation of acute coronary syndrome in peshawar over the last sixteen years

Background: Once considered as disease of the affluent and developed countries, coronary artery disease is emerging as epidemic in the developing world in general and South Asia in particular. Objective: To observe the trend of presentation of acute coronary syndrome in the local population over the last 16 years. Material and Methods: Clinical audit from 1995 to 2010 was carried out in which the data was retrieved from the computerised database of the Department of Cardiology, Lady Reading Hospital Peshawar. The period was divided into four quartiles, and the data of each quartile was analyzed for the total number of admissions, the type of ACS, whether ST-elevated MI or non-ST elevated ACS [comprising unstable angina and non-STEMI], age, gender and mortality. Results: The total admissions into the unit in the first quartile [1995–1998] were 23, 827, in the second quartile [1999–2002] 29, 005, in the third quartile [2003–2006] 33, 206 and in the fourth quartile [2007–2010] were 40, 110. Total ACS brunt constituted 8340 [35%], 10, 384 [35.8%], 12, 180 [36.68%] and 14, 920 [37.2%] patients respectively. The mean age of patients was 49.70 +/- 6.4 years, 48.21 +/- 7.2 years, 47.38 +/- 7.1 years and 46.81 +/- 6.2 years respectively. Women were 2356 [28.25% of the total ACS burden] in the first quartile, increasing to 3554 [34.225%], 4817 [39.55%] and 6281 [42.1%] in the following quartiles. STEMI constituted 45.88% [3826] of the total ACS presentations in the first quartile, 47.24% [4905] in the second, 49.55% [6035] in the third and 49.87% [7440] in the last quartile. The mortality rate, however, remained constant throughout [8.4% to 8.8%]. Conclusion: An increasing trend is seen in the burden of CAD in the local population with increasing presentation as STEMI. It is also evident that CAD is occurring at younger ages and more so in the female population

Pattern of coronary artery disease with no risk factors under age 35 years

Coronary artery disease [CAD] is no more deemed to be an ailment of the 4[th] or 5[th] decade; rather an earlier age incidence is not infrequently encountered in our population. However, there are a few data regarding CAD in young adults, and much about its underlying pathology still remains undetermined. The objective of this study was to delineate the coronary arterial disease pattern in adults under the age of 35 years, but having no known coronary risk factors. This prospective study was conducted at the Cardiology Departments of all 3 public sector tertiary care hospitals in Peshawar from Jun 2008 to Dec 2009. After having excluded the traditional risk factors for CAD, patients under the age of 35 years with objective evidence of CAD were subjected to percutaneous coronary angiography. Out of a total of 104 patients, 85 [81.73%] patients were men, and 19 [18.27%] were women. The mean age of the whole group was 32.66 +/- 3.237 [22-35] years. Significant CAD [>50% diameter narrowing of at least one major coronary artery] was found in 87 [83.7%] patients while 17 [16.3%] patients had non-atherosclerotic coronary artery disease, including 12 [11.53%] patients having normal coronary arteries, 1 [1%] patient had anomalous origin of right coronary artery [RCA], 1 [1%] patient had coronary arteritis, 2 [1.92%] patients had coronary artery ectasia, and 1 [1%] patient had a myocardial bridge over left anterior descending artery [LAD]. Among the patients with significant CAD, the prevalence rate of one, two and three vessel disease was 54 [51.9%], 22 [21.2%] and 11 [10.6%] respectively. Almost 50% of the lesions occurred in LAD followed by 25% in RCA and 20% in circumflex, while only one patient [1%] had isolated significant CAD of left main coronary artery. Osteal segments were involved in 10%, proximal in 61%, mid in 21% and distal segments in 7% of the lesions. In the younger age group, CAD is mostly a disease of men, single vessel CAD predominates with LAD involvement mostly, predominant osteal to proximal segment involvement of vessels, and a much higher incidence of normal coronaries and non-obstructive CAD is met with