Impact of blood transfusion on troponin I levels and outcomes after cardiac surgery: a cohort study

Objectives: Increased cardiac troponin I [TI] has been suggested to be a sensitive indicator of intraoperative myocardial injury. We investigated the association of transfusion on TI levels post-surgery and outcomes in patients undergoing elective cardiac surgeries

Methods: We conducted a retrospective review of 542 patients. Patients were divided into two groups based on TI levels at 24 hours [TI24] [> 6.5 microg/L vs.

Results: Red blood cell [RBC] transfusion was found to be associated with high TI levels [odds ratio [OR] = 2.33, p = 0.007, 95% confidence interval [CI]: 1.30–4.30]. A trend was observed when aortic cross-clamp time and preoperative ejection fraction were adjusted for [OR = 2.06, p = 0.080, 95% CI: 0.90–4.70]. An association was found between aortic cross-clamp time and high TI levels in the multivariable model [OR = 1.01, p = 0.028, 95% CI: 1.00–1.02]. Elevated TI levels was associated with higher mortality [OR = 4.15, p = 0.017, 95% CI: 1.29–13.08], renal failure [OR = 2.99, p = 0.004, 95% CI: 1.41-6.32], and increased length of stay in-hospital [OR = 4.50, p = 0.020, 95% CI: 0.69-8.30]

Conclusions: RBC transfusion is associated with increased TI24 post-cardiac surgery and worse outcomes, albeit a confounding effect cannot be excluded. Larger studies are required to confirm these findings

Epidemiology, outcomes and coronary angiography findings of patients following out-of-hospital cardiac arrest

Objectives: Out-of-hospital cardiac arrests [OHCAs] are a leading cause of death worldwide. However, data regarding the management and outcomes of affected patients are lacking in the Middle East. The current study aimed to present the angiographic findings and outcomes of patients presenting with OHCA in Muscat, Oman

Methods: This retrospective study took place between January 2012 and December 2016 at the Sultan Qaboos University Hospital [SQUH], Muscat, Oman. All adult patients who presented following an OHCA to the Emergency Department of SQUH during the study period were included. Demographic and clinical data were collected from electronic medical records

Results: A total of 216 patients were included in the study. The majority [63.9%] presented after having collapsed, while 22.3% presented with chest pains. Asystole was the most frequent initial cardiac rhythm [62.5%], with only 10% having ventricular tachycardia/fibrillation. Very few patients [1.4%] had received cardiopulmonary resuscitation [CPR] prior to presentation. In total, 85 patients [39.4%] returned to spontaneous circulation [RSC]; of these, post RSC electrocardiography revealed an ST-segment elevation in 41.2% and normal findings in 23.5%. There were 63 patients who underwent coronary angiography, with 28 requiring stenting. Overall, 13% of patients survived and were discharged, although three survivors suffered permanent hypoxic brain damage

Conclusion: The overall survival rate of patients who had experienced an OHCA was low. Education programmes should focus on the benefits of immediate CPR for individuals experiencing an OHCA, with more opportunities for CPR training to be made available to the general public in Oman

Troponin testing in the emergency department: real world experience

Objectives: The aim of this study was to examine patterns of troponin testing in the emergency department of a large tertiary care hospital in Oman and to determine its effect on patient management, including length of hospital stay [LOS]

Methods: This retrospective study analysed the medical records of all adult patients undergoing troponin testing in the emergency department of the Sultan Qaboos University Hospital, Muscat, Oman, during the month of July 2015. Patients who presented with an ST-elevation myocardial infarction were excluded

Results: A total of 4,845 patients attended the emergency department during the study period; of these, troponin tests were ordered for 588 patients. The majority of the patients had negative troponin test results [81.3%]. Chest pain, palpitations and breathlessness were the most common presenting complaints for those with positive troponin results. However, 41.8% of patients did not have any cardiac symptoms. Individuals with positive troponin tests had a significantly longer LOS compared to those with negative tests [mean: three versus one day; P = 0.001]. In total, only 28.2% of those with positive troponin test results had final diagnoses associated with a cardiac condition, such as heart failure, an acute coronary syndrome [ACS], atrial fibrillation or other types of arrhythmia

Conclusion: A positive troponin test was associated with increased LOS; however, only a small proportion of these patients had a final diagnosis associated with a cardiac condition. Guidelines should be provided to ensure that troponin testing is performed only in cases where an ACS is suspected

First reported case of arrhythmogenic right ventricular cardiomyopathy in oman

Arrhythmogenic right ventricular cardiomyopathy [ARVC] is a rare genetic disorder characterized by fatty degeneration of the right ventricular myocardium with variable involvement of the left ventricle. The condition is associated with exercise-mediated ventricular tachycardia and is one of the recognized causes of sudden cardiac death in the young and in athletes. Here, we report the first confirmed case of ARVC in Oman and present its electrocardiographic, echocardiographic features, and radiological findings on gated, contrast-enhanced cardiac computed tomography

Our patient was a 22-year-old male who had presented to our hospital for evaluation and investigation of syncope and symptomatic palpitations

Spontaneous coronary artery dissection: an under-recognized cause of acute coronary syndromes

Spontaneous coronary artery dissection [SCAD] is a rare condition that is often underdiagnosed given limitations of conventional cineangiography

In addition to the diagnostic challenge, the condition poses a major therapeutic dilemma given paucity of literature to guide management. We report the case of a 55-year-old woman, who presented with acute coronary syndrome

Coronary angiography at the time of the index hospitalization revealed type 2 SCAD. She was managed conservatively. Repeat coronary angiography three months later showed complete resolution of the previously noted dissection. Because of the high association between SCAD and fibromuscular dysplasia [FMD], a cross-sectional imaging was performed in this case, which ruled out underlying FMD. The patient has been followed longitudinally since her index event and has had no reported recurrences

Reproducibility of manual platelet estimation following automated low platelet counts

Objectives: Manual platelet estimation is one of the methods used when automated platelet estimates are very low. However, the reproducibility of manual platelet estimation has not been adequately studied. We sought to assess the reproducibility of manual platelet estimation following automated low platelet counts and to evaluate the impact of the level of experience of the person counting on the reproducibility of manual platelet estimates

Methods: In this cross-sectional study, peripheral blood films of patients with platelet counts less than 100 × 109 /L were retrieved and given to four raters to perform manual platelet estimation independently using a predefined method [average of platelet counts in 10 fields using 100× objective multiplied by 20]. Data were analyzed using intraclass correlation coefficient [ICC] as a method of reproducibility assessment

Results: The ICC across the four raters was 0.840, indicating excellent agreement. The median difference of the two most experienced raters was 0 [range: -64 to 78]. The level of platelet estimate by the least-experienced rater predicted the disagreement [p = 0.037]. When assessing the difference between pairs of raters, there was no significant difference in the ICC [p = 0.420]

Conclusions: The agreement between different raters using manual platelet estimation was excellent. Further confirmation is necessary, with a prospective study using a gold standard method of platelet counts

Acute myocardial infarction after switching from warfarin to dabigatran

Dabigatran etexilate is a recently approved direct thrombin inhibitor [DTI], which is superior to warfarin in the prevention of stroke and systemic embolism in patients with atrial fibrillation [AF]. However, dabigatran use is associated with an increased risk of myocardial infarction [MI] compared to warfarin. The mechanisms for this association effect remain speculative. We present a case of an acute MI and cardiac arrest in a patient with chronic AF who had been recently switched from warfarin to dabigatran. Urgent coronary angiography, at St. Michael's hospital [Toronto, Canada], revealed evidence of thromboembolism to the distal posterior descending artery. The patient was treated medically and switched back from dabigatran to warfarin. He did well and was discharged after an uneventful stay in the coronary care unit