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Objective: This study has evaluated risk factors, especially dyslipidemia, for an acute myocardial infarction (AMI) in postmenopausal women. Materials and Methods: This was a hospital-based, observational, single-center study among 100 postmenopausal women admitted to the medicine ward with AMI. They were categorized based on lipid profile groups, viz., dyslipidemic group and non-dyslipidemic group. All clinical parameters were studied between the groups. Results: Among anthropometric profiles, in the comparison of mean height (cm), weight (kg), body mass index (BMI) (kg/m2 ), and waist circumference (WC) (cm) for the dyslipidemic group and non-dyslipidemic group, only WC was statistically significant (P < 0.001). Most patients were hospitalized between 6 and 12 h after the onset of symptoms. At the time of hospitalization, most patients from both groups were observed to have diabetes and hypertension with poor control of postprandial blood sugar, glycated hemoglobin, and diastolic blood pressure (DBP) (P < 0.05). The dyslipidemic group’s mean C-reactive protein was higher (P < 0.05). The comparison of mean total cholesterol, triglyceride (TG), low density lipoprotein-cholesterol in mg/dL, and TG: high density lipoprotein was significantly increased (P < 0.001), while high density lipoprotein-cholesterol (mg/ dL) was significantly decreased (P < 0.001) in the dyslipidemic group. ST-segment elevation myocardial infarction is standard in both groups. The maximum patient has regional wall motion abnormality in echocardiography after day 3 of admission. Among the dyslipidemic group, ejection fraction was on the lower side, and the predominant complication was in the left ventricular failure (LVF) (P < 0.05). Conclusion: WC has a positive association with patients with AMI who have dyslipidemia and can be used as an indicator of the risk of AMI when BMI is normal. WC is a surrogate marker of abdominal fat mass (subcutaneous and intra-abdominal); increased WC is a significant component marker of metabolic syndrome and insulin resistance related to cardiovascular mortality. There was poor glycemic control and blood pressure (mainly DBP) among the dyslipidemic patients. Hypertriglyceridemia is the most common lipid abnormality, followed by hypercholesterolemia among the dyslipidemic group. LVF is the most common complication in dyslipidemic patients.
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Objective: The elevation of troponin-T (Trop-T) or creatinine kinase myocardial isoform (CKMB) is very common during the percutaneous coronary intervention (PCI). A study was attempted to determine the correlation between elevated Trop-T or CKMB and the parameters of PCI by using multivariate analysis, especially principal component analysis (PCA). Materials and Methods: A prospective observational study was carried out among 100 patients who underwent PCI for stable coronary artery disease in which 31 and 37 patients were found to have elevated Trop-T and CKMB (>3 times) following PCI. The correlation was studied between Trop-T or CKMB (dependent variable) and different parameters, viz., total stent length (mm), fluoroscopy time (min), lesion strength, left ventricular (LV) function, procedural complications, type of lesions, vessels treated with drug eluting stent (DES), and major adverse cardiac events (MACE) as independent variables. Results: For Trop-T, the principal component (PC)-1 and PC-2 obtained 63.49% and 30.88% of the original variation. For PC-1 and PC-2, maximum positive loading was recorded for stent length followed by fluoroscopy time and for LV but negative loading for the type of lesion and type of stent (DES vs bare metal stent [BMS]). For CKMB, the PC-1 and PC-2 obtained 61.22% and 32.08% of the original variation. For PC-1 and PC-2, maximum positive loading was recorded for stent length and fluoroscopy time followed by vessel treated but negative loading for the type of stent and MACE, and maximum positive loading recorded for LV function but negative loading for the type of lesion. Conclusion: This study indicates which factors are most important in preventing periprocedural myocardial injury during PCI and may be a suitable tool to prevent myocardial injury and for subsequent less MACE and better patient outcomes.
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Background: The objective was to measure the correlation between carotid intima medial thickness (CIMT) with duration of type 2 diabetes mellitus (DM) and its correlation with biochemical markers and body mass index (BMI). Methods: The study was conducted in a tertiary care hospital in Kolkata. Total 100 patients were selected randomly who met the inclusion criteria. Among total patients, 20 cases were newly detected type 2 DM patients and 80 were cases of established diabetes, with different duration of DM. CIMT was measured by carotid artery ultrasonography using an echo tomography system having midfrequency of 7.5MhZ and detection limit of 0.1mm. Duration of diabetes was measured as present age minus age of detection of DM. BMI was measured by the guideline of WHO. The parameters were estimated such as microalbuminuria by radioimmunoassay, fasting blood sugar (FBS) level and HbA1C by HPLC method, uric acid by uricase method. Data was collected using a predetermined proforma and statistical analyses were done. Results: Duration of DM was positively correlated with CIMT and association was statistically significant (P<0.02). There was increase in CCA-IMT and ICA-IMT across increasing level of FBS and HbA1c (P<0.01). Microalbuminuria is considered a novel atherosclerotic risk factor, was found significantly associated with mean CIMT (P<0.001). CIMT was also significantly associated with HbA1C (P<0.001). The significantly (P<0.01) increased level of uric acid indicated higher carotid plaque. Conclusion: CIMT is an objective measure of subclinical atherosclerosis, which is a non- invasive, less expensive, duration and reproducible way of demonstrating subclinical atherosclerosis. Thus, it can serve as a window for atherosclerosis status in other major arteries like coronary artery and cerebral arteries. The CIMT is closely associated with several markers viz. uric acid, blood sugar, HbA1c, albumin and BMI during the progression of type 2 DM.
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Background: The elevation of troponin-T (Trop-t) and creatinine kinase myocardial isoform (Ckmb) and elevation of these markers lead to major adverse cardiac events (MACEs). The association between above-mentioned parameters along with electrocardiogram (ECG) changes can be suitable diagnostic tool for myocardial injury following percutaneous coronary intervention (PCI). The present study was attempted to know the association of the changes in surface ECG and cardiac biomarkers and MACEs following PCI with the outcome in follow up among patients in eastern India. Methods: In present study, 100 patients were randomly selected for coronary angioplasty between April2012 to March2013. All the cases were referred to catheterization laboratory for elective PCI for single vessel or multivessel in native coronary artery. The biomarkers such as trop-t and Ckmb and MACEs along with changes in ECG were estimated as per standard protocol. Results: ECG changes were statistically significantly correlated with post procedure Trop-t elevation (p<0.001), Ckmb elevation (p<0.001) and MACEs (P<0.01 and p<0.001) in 6 months followed up. Conclusion: In conclusion, the present study showed significant relationship between MACEs during followed up and changed in surface ECG along with Trop-t and Ckmb elevation in the post-PCI period of six-month followed up in stable ischaemic heart disease.
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Polycythemia vera (PV) is a chronic myeloproliferative disorder characterized by a high risk of developing arterial and venous thromboembolic complications. In recent years, great insight has been gained into the understanding of the pathogenesis of thrombosis in PV. Diagnosing and managing a case of acute coronary syndrome (ACS) due to non-atherosclerotic causes is a challenge. In this case report, we share our experience in diagnosis, management and revascularization issues in non-ST-elevation myocardial infarction (NSTEMI) in a patient with polycythemia vera background.
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Background: Cardiac troponin (CTnT) and creatinine kinase myocardial isoform (CKMB) are suitable marker for myocardial injury following percutaneous coronary intervention (PCI). Elevation of these markers lead to major adverse cardiac events (MACEs). The objective was to detect the elevation of serum CTnT and CKMB during post-PCI period and identify MACE during six-month followed up among patients in eastern Indian. Methods: In present study, 100 patients were randomly selected for coronary angioplasty between April2012 to March2013. All the cases were referred to catheterization laboratory for elective PCI for single vessel or multivessel in native coronary artery. The CTnT and CKMB parameters were estimated as per standard protocol. The categorization was done on the basis of baseline (normal value), ≤3time and >3time elevation for both the biomarkers and respective MACEs as MACE-1, MACE-2, MACE-3, MACE-4 and MACE-5 were determined. Results: There were more MACE in patients in six month follow up who sustainned >3times elevation in CTnT and CKMB during pos-PCI period. There was highly significant correlation (P<0.001 and P<0.01) with increasing trend of CTnT and CKMB elevation and risk of MACEs. MACEs were significantly (P<0.001 and P<0.01) correlated with diabetes mellitus, hypertension, renal dysfunction, fluoroscopy time, stent length, left ventricular ejection fraction and type of lesion. It was also observed that more hospital stay led to elevation of CTnT and CKMB. Conclusions: It is concluded that the elevation of CTnT and CKMB in serum during post-PCI can predict MACEs in six-month follow up in stable ischaemic heart disease.