Correlation of global registry of acute coronary events [GRACE] with the angiographic severity and extent of coronary artery disease in patients with non- ST elevation acute coronary syndrome

To determine whether the GRACE risk score correlates with the angiographic extent and severity of coronary artery disease in patients with NSTE-ACS undergoing cardiac catheterization. We conducted a cross sectional descriptive study in 154 patients with NSTE-ACS admitted at AFIC-NIHD from 1[st] April to 30[th] September 2011. For each patient the GRACE risk score was calculated by using specific variables collected at admission. The extent and severity of coronary artery disease was evaluated on angiography for each patient. A total of 154 patients were included in the study. The average age of the patients was 55.81years. Majority [75%] of the patients was male and 25% were females. The mean GRACE score was 132.85. Overall 40 patients had low, 54 had intermediate, and 60 had high GRACE risk score. Among patients with low score 28 had SVCAD, 4 patients had DVCAD and none of the patients had TVCAD. In the intermediate group 24 patients had SVCAD, 18 had DVCAD and 6 had TVCAD whereas among the high GRACE risk score 4 patients had SVCAD, 24 had DVCAD and 32 had TVCAD. Regarding the severity of coronary artery disease; among the low GRACE risk score patients; 8 had subcritical and 32 had critical CAD. In the intermediate GRACE risk score subset of patients, 6 had subcritical and 48 had critical CAD and none of the patients of high GRACE risk score had subcritical CAD and all 60 patients had critical CAD. GRACE risk score is a valuable noninvasive tool in predicting the extent and severity of CAD

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

Procedural outcome of primary PCI inst-segment elevation myocardial infarction at Afic and Nihd Rawalpindi - Pakistan

To determine the procedural outcome of primary percutaneous coronary interventions [PCI] in ST segment elevation myocardial infarction. A quasi-experimental study. Armed Forces Institute of Cardiology and National Institute of Heart Diseases, a tertiary care cardiac institute from November 2011 to September 2013. Total 228 patients who underwent primary percutaneous intervention [primary PCI] were included in this study. A pre designed performa was prospectively filled which included demographic and procedural variables. Procedural success and in hospital mortality were recorded. The mean age was 59 +/- 10.88 years. There were 205 [89.9%] males, 80 [35.1%] patients were found to be diabetic, 47 [20.6%] hypertensive, and 90 [39.5%] patients were smokers. Family history of ischemic heart disease was positive in 51 [22.4] patients. Anterior, inferior and lateral myocardial infarction were present in 137 [60.1%], 90 [39.5%] and 1 [0.4%] patients respectively. The Median time from the onset of symptoms to the arrival in the hospital was 122.5 +/- 142.57 and median door to balloon time was 60 +/- 22.88 min. Left anterior descending [LAD] was the commonest infarct related artery accounting for culprit artery in 138 [60.5%] followed by right coronary artery [RCA] and left circumflex artery [LCX] in 72 [31.6%] and 18 [7.9%] cases respectively. Procedural success was achieved in 222 [97.4%] patients. Six [2.6%] patients died in the hospital. High success rate with low mortality rates can be achieved in our set up. However more studies and long term follow up is required to validate our results

Coronary artery disease in the elderly

The objective of our study is to assess the severity of coronary artery disease in the elderly and predict the safety outcome of coronary angiography. A cross sectional observational study. AFIC/NIHD Rawalpindi. February 2011 and August 2011. The study population included 100 elderly patients [age>60 years] undergoing coronary angiography. Coronary angiography data were obtained from the Siemens Queries software system, which maintains the database including detailed angiographic findings of all patients at this institution. Significant lesions were defined as those with >70% diameter narrowing of coronary arteries [>50% for the left main coronary artery]. We attempted to quantify the "severity of CAD" by ascertaining the prevalence of high-risk coronary anatomy [HRCA, defined as >50% stenosis of the left main coronary artery and/or significant three-vessel coronary artery disease]. More than 70% stenosis in more than one coronary artery was considered as severe coronary artery disease. Our study cohort comprised of 100 consecutive subjects 82 [82.0%] men and 18 [18.0%] women with a mean age of 78.6 years [Range 70 years - 94 years]. 77 patients [77.0%] had severe coronary artery disease; 50 with triple vessel coronary artery disease [TVCAD] 1 with TVCAD with Left Main Stem Disease, 26 had double coronary artery disease [DVCAD]. 12 patients [12.0%] had moderate coronary artery disease with single vessel involvement [SVCAD], 6 patients [6.0%] had subcritical coronary artery disease with < 60% stenosis in any of the vessel while only 5 patients [5%] had a normal coronary angiogram. Patients of elderly age group have more severe CAD and coronary angiography is a relatively safe procedure.

Dual source multislice computed tomography for pulmonary embolism: initial experience at AFIC/NIHD Rawalpindi

Observation of different computed tomography findings in patients suffering from pulmonary embolism. All patients who underwent computed tomography for pulmonary embolism and had positive findings of pulmonary embolism, were included in the study. Armed Forces Institute of Cardiology/ National Institute of Heart Disease, between April 2009 and October 2010. Patients on mechanical ventilation were excluded from the study. CT pulmonary angiograms were obtained with 64 slice dual source computed tomography [DSCT] machine [Somatom definition] from Siemens. Before scanning breath holding was taught. A craniocaudal acquisition was obtained with a collimation of 64 x 0.6 mm and a pitch of 1.2-1.4. Total number of patients included in the study were 34 with mean age 50 years. The mean of Score by Miller was 10 +/- 5.532 and the mean percentage obstruction by method of Miller was 62.5%. The mean of Score by Qanadli was 19.62 +/- 12.32 and the mean percentage obstruction by method of Qanadli was 49.04%. The mean of Score by Mastora was 54.53 +/- 33.27 and the mean percentage obstruction by method of Mastora was 35.18%. Calculated mean and SD of right ventricular [RV] diameters was 44 +/- 7.75mm, left ventricular [LV] diameter was 32 +/- 8.06mm, RV/LV ratio was 1.508 +/- 0.58 mm, main pulmonary artery [PA] luminal diameter was 29 +/- 4.16mm, ascending aorta size was 32.46 +/- 5.14mm, PA/Aorta ratio was 0.913 +/- 0.188mm, Azygos Vein diameter was 11.14 +/- 1.88mm and superior vena cava [SVC] diameter [at azygos arch] was 18.93 +/- 3.37 mm. Correlation between methods was generally significant. Reflux of contrast injection was noted in 24 out of 34 patients, leftward bowing of inter-ventricular septum was observed in 21 patients, pleural effusion was noted in 10 patients and pericardial effusion was seen in only 3 patients. CT pulmonary angiography has emerged as a reliable non invasive tool for not only confirmation of diagnosis of pulmonary embolism in short time but also gives valuable information about prognosis of these critically ill patients. Further it can provide accurate follow up of thrombolytic therapy and can help plan an interventional strategy

Coronary artery anomalies; An AFIC/NIHD experience

Introduction: Congenital anomalies of the coronary arteries occur in 0.2% to 1.2% of the general population1. The incidence of various coronary anomalies and associated clinical, angiographic and hemodynamic findings have been cited in several internationally published clinical series4-8. To compare our experience with previously reported studies, we have reviewed clinical and angiographic findings for 50 adult patients with coronary artery anomalies. We surveyed the records of 5050 consecutive adult patients who had undergone coronary angiography. Armed Forces Institute of Cardiology and National Institute of Heart Disease [AFIC/NIHD] Rawalpindi. 1[st] Jan 2004 and 30th April 2005, and identified 50 adults with various coronary artery anomalies. 5050 reports were reviewed and 50 [0.9%] coronary artery anomalies were identified in 50 patients. Different anomalies identified are; both coronary arteries from right sinus of Valsalva [RSV]-[n = 1], both coronary arteries arising from the left coronary sinus [n = 4], single coronary arteries [n = 2], LCx from RSV/RCA [n=6], anterior descending artery arising from the right coronary sinus [n = 1], coronary artery fistulae [n = 4], separated origin of anterior descending and left circumflex coronary arteries [n = 25], and separate origin of conus/ RV branch [n = 7]. The initial course was retroaortic in all the circumflex arteries, interarterial in the right coronaries, and anterior in the anterior descending arteries. We conclude that adult congenital anomalies of the coronary arteries are not uncommon finding in a tertiary care cardiac center. Separate origin of LAD and LCx from LSV and left circumflex coronary artery arising from RSV/RCA are the most frequently diagnosed anomalies