Frequency and angiographic characteristics of coronary artery ectasia in patients undergoing coronary angiograms at AFIC and NIHD

To determine the frequency and angiographic characteristics of coronary artery ectasia in the patient population of AFIC and NIHD. Descriptive Study Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from Jan 2007 to Dec 2011. All coronary angiograms done during the period were included in the study. The reports of coronary angiograms of those patients who were diagnosed to have coronary artery ectasia were left circumflex artery reviewed to assess the distribution of ectasia in different coronary arteries. Concomitant significant coronary artery stenosis left ventricular [LV] systolic function and history of revascularization were also documented. Over the study period, a total of 41,459 patients underwent coronary angiograms. 548 [1.32%] patients were diagnosed to have coronary artery ectasia. Out of these 467 [85.21%] patients were males and 81 [14.78%] were females. Their mean age was 53.7 years. Left anterior descending [LAD] was the coronary artery, most commonly affected by ectasia followed by left circumflex artery [LCx] and Right coronary artery [RCA]. Twenty three patients also had ectasia of left main stem. Four Hundred and three [73.54%] patients also had concomitant occlusive coronary artery disease and 19.52% patients had history of coronary revascularization either by percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]. Coronary artery ectasia is not a benign disorder as it could present as acute coronary syndrome having its own morbidity and mortality

Early in-Hospital re-infarction after thrombolysis for acute myocardial infarction [AMI] in AFIC/NIHD Rawalpindi

This study was designed to determine the frequency and variables of in-hospital re-infarction after streptokinase in patients with first acute ST segment elevation myocardial infarction [AMI], hospitalized in CCU of AFIC/NIHD from Feb 2002 to July 2002. Of 200 consecutive patients of AMI who received streptokinase, 73% [n = 146] were males and 27% [n = 54] were females, mean age was 55.5 years [29-81]. Frequency of in-hospital re-infarction documented in this study was 6.5% [n = 13] a median time of 2.5 days [1-6] after thrombolysis. Patients with re-infarction had higher in-hospital mortality within ten days of hospitalization [30.77% versus 7.5% without re-infarction; P = .01]. Median time to death after re-infarction was 3 days [2 - 10] with 50% of deaths occurring within 48 hours of re-infarction. Rates are comparable with previously conducted large-scale studies [GUSTO I/III and TAMI study]. Advanced age, diabetes mellitus, hypertension, increasing killip class > at the time of admission, fluctuation in heart rate and hyperilipidaemias were the most important predictors /variables associated with higher in-hospital re-infarction and subsequent increased morbidity and mortality. Improved treatment, preventive strategies and early detection of re-infarction should be an important goal of AMI management. Repeat thrombolysis and early revascularization where possible in selected cases can decrease the cardiac mortality and morbidity