comparative study of the C - reactive protein and the ST-score [ECG] as prognostic indicators in acute myocardial infarction in a rural resource-constrained hospital setting in central India: a cross-sectional study

The electrocardiogram remains a crucial tool in identification of acute myocardial infarction [AMI]. High sensitivity C-reactive protein [hs-CRP] has been found to be strong predictor of coronary artery disease [CAD] and future cardiovascular events. The aim of the present study was to compare hs-CRP and ST-Score [STS] as prognostic indicator in acute ST segment elevated myocardial infarction [STEMI] in central rural India. Cross sectional study, rural hospital in central India. In all patients of STEMI, STS, ST index and hs-CRP were measured on admission and serially. The Primary outcome was all cause mortality at 30 days. Secondary outcome were heart failure, life threatening arrhythmia, cardiogenic shock, re-infarction, hospital stay and re-admission. We used Student's t test to compare means, Chi-square test to compare proportions and Mann Whitney test to compare medians. P value <0.05 will be considered significant. Crude odds ratios were computed to assess the strength of association between risk factors and independent variable along with 95% confidence intervals. STS was significantly higher in patients with poor outcome, when compared with good outcome [20.27mm vs.12.47mm, P = 0.002]. On multivariate regression model STS was significant predictor of composite outcome events [OR = 2.74; 95% [CI], 1.46 to 5.17; P = 0.002]. The area under the ROC curve was 0.70, with sensitivity of 73.5%, specificity of 58.7%; PPV of 68.3% and NPV of 64.2%. hs-CRP in patients with poor outcome vs. good outcome [6mg/L vs. 3.74mg/L, P = 0.003] and [P = 0.06, 0.85 and 0.12] respectively. STS on admission is independent predictor while hs- CRP is not in resource constrained settings.

rare case of situs inversus with dextrocardia, Lutembacher syndrome, and pericardial effusion

Incidence of congenital cardiac anomalies in dextrocardia with situs inversus is low as compared to congenital cardiac anomalies in isolated dextrocardia. We describe the first ever case of situs inversus with dextrocardia, Lutembacher's syndrome, and pericardial effusion. The pericardial effusion in our case was acquired and was tubercular in etiology