Characteristics and in Hospital Clinical Outcome of Patients with Non St-Segment Elevation Myocardial Infarction with Chronic Kidney Disease.

Background: Nearly 40% of patients presenting with Non ST-Segment Elevation Myocardial Infarction (NSTEMI) have Chronic Kidney Disease (CKD). CKD is a powerful predictor of adverse events among NSTEMI patients. The purpose of the present study was to evaluate the in-hospital outcome of patients with Chronic Kidney Disease presenting with Non ST-Segment Elevation Myocardial Infarction. Methods: In this prospective observational study a total of 128 patients with NSTEMI were enrolled. They were divided equally in group I (NSTEMI with CKD) and group II (NSTEMI with normal renal function) on the basis of estimated glomerular filtration rate. Patients were considered to have CKD if he/she had documented history of CKD or estimated glomerular filtration rate <60 mL/min/1.73 m². Presence of inhospital complications was identified. Results: Patients with CKD were significantly older, with a greater prevalence of hypertension, diabetes mellitus, lower left ventricular ejection fraction, and lower haemoglobin level compared with those without CKD. CKD patients had more atypical presentation during admission. In-hospital complications were significantly higher in CKD patients presenting with NSTEMI. Conclusion: CKD strongly predicts adverse in-hospital outcome among NSTEMI patients.

Comparison and outcome of commissurotomy by metallic valvotome and balloon commissurotomy.

The purpose of this study was to compare the echocardiographic outcome of percutaneous transvenous metallic mitral commissurotomy (PMMC) and Percutaneous transvenous balloon mitral commissurotomy (PTMC). This prospective comparative study was carried out during the period of January 1999 to June 2000 in the department of Cardiology, National Institute of cardiovascular diseases (NICVD) and national heart foundation hospital, Dhaka Bangladesh. Two dimension, M-mode, spectral and colour Doppler studies were done to all patient of mitral stenosis both before and after PMMC and PTMC. The increased in mitral valve area in PMMC was statistically significant than PTMC. (P<0.047).

Angiographic severity and extent of coronary artery disease in patients with type 2 diabetes mellitus.

Coronary angiographic characteristics of fifty patients with type 2 diabetes mellitus and coronary artery disease (CAD) were compared with fifty non diabetic patients with CAD. Type 2 diabetic patients undergoing clinically indicated elective coronary angiography were individually matched with fifty non diabetic coronary artery disease patients for age, sex and major risk factors. No significant difference was present between the mean age, presenting complains and other coronary risk factors between the two groups. Severity and extent of coronary artery involvement was assessed by a coronary artery score (CAS) using the segmental distribution method for coronary artery lesions and morphometric analysis of atherosclerotic lesion was done. Type 2 diabetic patients had a higher CAS (11.74+/-5.04 vs 8.72+/-4.87; P<0.001) as compared to the non-diabetic patients. Multivessel disease were more prevalent in both the groups (82% vs 68%; P>0.05) but diabetic patients had significantly higher number of triple vessel disease (58% vs. 38%; P<0.001). Normal coronary arteries and single vessel disease were more prevalent in non-diabetic patients (32% vs. 18%; P<0.05). As compared to non-diabetic group diabetic patients had a higher total number of diseased vessels (78.66% vs. 68%; P<0.01), a higher lesion per patient ratio (3.94+/-1.80 vs 3+/-1.67:P<0.001) and more proximal lesions (40.83% vs. 34.70%; P>.05) though not statistically significant. Morphometric analysis of coronary artery lesions revealed that diabetic patients had significantly higher number of multiple irregularity lesions (24.37% vs. 15.33%; P<0.01) and lesions were more obstructive (lesion involving 70-90% of coronary lumen: 70.53.% vs. 57.33%; P<0.05). Though there was no significant difference between the systolic left ventricular function between the two groups but significant higher regional wall motion abnormality was found more in diabetic patients (76%vs 62%; P<0.01). So type 2 diabetic patients had more severe and extensive atherosclerotic lesion in their coronary arteries than the matched non diabetic control on coronary angiography suggesting an independent effect of diabetic mellitus on atherosclerotic process specially in our population.

Coronary artery disease in young adults - angiographic profile.

Angiographic profile of fifty young patients of coronary artery disease aged 40 or under were analysed and compared with those of fifty older patients. Mean age of younger and older group was 36.34 (range 28 to 40 years) and 55.28 (44-74 years) years respectively and most of the patients were male in both the group (92 Vs 94%). Older patients were more diabetes (40 Vs 24%) and hypertensive (38 Vs 60%) but the younger patients had more family history of premature coronary artery disease (50% Vs 24%). The incidence of smoking and dyslipidemia did not vary between the two groups. Older patients had more history of myocardial infarction (69 Vs 58%) but angina were more in young patients (42 Vs 31%). Coronary angiography revealed more number of multivessel disease in older patients (74 Vs 54%) but the younger patients had more normal coronary arteries and single vessel disease (46 vs 26%). Coronary athesclerosis was also extensive in older patients as revealed by the higher coronary score, more involvement of coronary segments, more number of diseased and diffusely involved coronary vessel in older patients. Older patients needed more revasalarization process (74 Vs 60%), more coronary bypass surgery (40 Vs 24%) and had more inoperable vessels (16% Vs 4%) than the younger patients. So the younger patients having less extensive coronary artery athesclerosis with better prognostic probability should be evaluated angiographically for further definitive management in the from of revascularization.

Correlation between severity of coronary artery athesclerosis and duration and severity of diabetes mellitus in type 2 diabetic patients.

Hundred patients of Type 2 diabetes mellitus with coronary artery disease undergoing diagnostic coronary angiography were studied to determine the relation between the severity and duration of diabetes mellitus and the severity of coronary artery disease. A coronary scoring system using segmental distribution method was used to determine the severity of coronary artery disease and severity of diabetes was assessed by the level of fasting blood glucose within 48 hours of the procedure and also considering the types of treatment received for diabetes mellitus. No significant correlation was demonstrated between the severity of coronary artery disease and the severity (r =.089602; P>0.1) nor the duration (r =0.07865; P> 0.1) of diabetes mellitus on univariate analysis. So the Type 2 diabetic patients had an increased incidence of atherosclerosis in their coronary angiograms did not reflect an angiographically evident progressive coronary artery disease and results of this study suggest that the progress of large vessel coronary athesclerotic disease in diabetes mellitus of adult onset takes place independently of the progress of diabetes mellitus itself.

Coronary artery disease in young patients: clinical review and risk factor analysis.

Fifty consecutive younger patients (< or = 40 years) with coronary artery disease, who underwent coronary angiography in National Institute of Cardiovascular Diseases were evaluated clinically and coronary risk factors were analyzed and compared with those of fifty older patients with coronary artery disease. Mean age of younger and older patients were 37.31 and 54.58 years respectively and myocardial infarction was the most common presenting complain in both the groups. Smoking and family history of premature coronary artery disease were more common in younger patients but the older patients were more diabetic and hypertensive. Central obesity and dyslipidemia did not vary between the two groups. Fifty percent of younger patients had one or two modifiable risk factors where sixty four percent of older patients had three or more modifiable risk factors. Forty four percent younger patients had hypercholesterolemia but a majority of patients had either isolated hypertriglyciredemia or decrease high density lipoprotein cholesterol or both with normal total cholesterol level but the total cholesterol and high density lipoprotein cholesterol index were more than 4.5. Younger patients had more number of normal coronary or single vessel diseases but older group had more number of triple vessel diseases. So the higher incidence of non-insulin dependent diabetes mellitus with central obesity suggesting insulin resistance along with unique profile of dyslipidemia, higher incidence of smoking and familial predisposition of premature coronary artery disease may be responsible for higher incidence of coronary artery disease at a premature younger age in this population.