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

Greek technique for type 4A coronary artery bifurcation lesions

In routine coronary angiography, bifurcation lesion is not uncommon. Current practice of dealing with type 4a coronary bifurcation lesions [lesions of main branch without significant lesions of the side branch] may lead to true bifurcation lesions after stenting due to axial plaque redistribution. This series describes an experience with Greek technique for treatment of type 4a bifurcation lesions in 18 patients for primary stenting of main vessel with simultaneous kissing balloon of side branch in an effort to avoid snow plough effect

Local experience of intravascular ultrasound [IVUS] in intermediate coronary artery lisions

To evaluate intermediate lesions by Intravascular ultrasound [IVUS] for its severity. Design: Observational study. Place and duration of study: Patients undergoing coronary angiography at catheterization laboratory, National Institute of Cardiovascular Diseases Karachi, in the period between 01-01-2000 to 15-03-2001. Seventeen patients with intermediate coronary artery lesions with interobserver discrepancy underwent IVUS study. Out of seventeen patients with intermediate lesions, 70% had LAD [Left Anterier Descending] Lesions 24% had RCA [Right Coronary Artery] and 6% had Cx [Left Circumflex Artery] lesion. IVUS showed severe lesion in all the patients. IVUS revealed that intermediate lesions visualized by coronary angiography had severe lesions

Role of intravascular ultrasound [IVUS] in evaluating optimal inflation and size of stents and balloon in patients undergoing percutaneous coronary interventions [PCI]

Objective: To evaluate the size of balloon and stent and inflations given to patients undergoing PCI before and after IVUS. Design: A retrospective study. Place and duration of study: This retrospective study was conducted at department of catheterization laboratory National Institute of Cardiovascular Diseases [NICVD] Karachi from 1998 to 2001

Subjects and Methods: All patients who have undergone PCI in catheterization laboratory NICVD from 1998 to 2001 were included. These patients include those who have undergone IVUS in between year 2000 and 2001

Results: IVUS study and use of stents and balloon in four years showed that mean diameter of stent in males used increased from 3.05 mm to 3.13 mm and mean length reduced from 18.32 mm to 15.22 mm with inflations ranged from 9.30 atm to 13.4 atm. For Balloons mean diameter decreased from 2.7 mm to 2.6 mm and mean length reduced from 20.9 mm to 19.24 mm with inflations that increased from 5.04 atm to 6.4 atm. In females stent used with mean diameter that increased from 2.96 mm to 3.08 mm and mean mean length decreased from 18.33 mm to 15.47 mm and inflation increased from 9.33 atm to 12.69 atm. Balloon used with mean diameter that decreased from 2.9 mm to 2.6 mm with length that decreased from 20.8 mm to 19.04 mm and with inflations 6.20 atm to 5.80 atm

Conclusion: This study showed that IVUS demonstrated a significant increase in stent expansion after IVUS. Mean length of stent and balloon used decreased yearly. Mean diameter of stent used were increased while that of balloon decreased after IVUS

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