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

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