Predictive value of neutrophil/lymphocyte ratio in predicting complications after non st elevation myocardial infraction

A Cross sectional study conducted in Cardiology Unit, Hayatabad Medical Complex from August 2011 to February 2012. In a total of 250 patients with non ST elevation MI were enrolled in study. Neutrophil to lymphocyte ratio [NLR] was determined. Those with high NLR were followed over two week period to detect in hospital mortality; Atrial Fibrillation and ST segment Deviation. Association of cellular response with the incidence of post-MI mortality/complications was assessed by multiple logistic regression analyses. There were 250 patients comprising of 154 [61.60%] males and 96 [38.40%] females. The overall mean age was 51.57 +/- 12.5 years. The frequency of high neutrophil to lymphocyte ratio was present in 78 [31.20%] patients. The In hospital mortality and atrial fibrillation rate was in 10.26% and 11.54% cases respectively while ST segment deviation was in 57.69% patients. Patients with Non ST Segment elevation Myocardial Infarction with high Neutrophil to lymphocyte ratio, is a good predictor of In hospital mortality, atrial fibrillation and ST segment deviation. Thus a single CBC analysis may help to identify Non- STEMI patients at risk for mortality and complications.

Clinical profile of patients with normal coronary angiogram

To observe the clinical and bio-chemical profile of patients having normal coronary angiogram following an abnormal stress test. This was a single center retrospective, descriptive study. Coronary angiograms done from July 2009 to December 2011 were retrieved and reviewed for normal coronary arteries. Clinical and bio-chemical profile of the patients having normal coronary angiogram was retrieved from hospital record. Patients, whose computerized data could not be retrieved from department database, were excluded from the study. Out of 8425 angiograms reviewed, 816[9.7%] were having normal coronary arteries. Mean age was 4 +/- 27.4 years. Females were 66.7%. Clinical and biochemical profile for normal coronary angiograms was as follows: smokers 59%, family history of premature coronary artery disease 41%, hyperlipidemia18.5% and hypertension 14%. Diabetes was present only in 2.1%. Among females: 11% were current users of oral contraceptives pills, 3.4% were post menopausal and 0.87% pregnant. Mean BMI was 25.4 +/- 5.2 and total cholesterol and triglyceride were 278 +/- 31mg/dl and 180 +/- 28mg/dl respectively. Normal coronary angiogram is infrequently observed in catheterization laboratories and mostly found in younger to middle aged females. Smoking is very common in such patients. Hyperlipidemia, hypertension, diabetes mellitus are not frequently present in these patients.

Comparison of effect of locally available brands of clopidogrel on platelet aggregation in patients with coronary artery disease

Anticoagulant effect of clopidogrel is of utmost importance in coronary artery disease, especially in prevention of coronary stent thrombosis. Recently, many new local brands of clopidogrel have been launched, with unknown efficacy. This study was conducted with the aim to compare two locally prepared clopidogrel brands, in terms of the effect of a loading dose of 600 mg on inhibition of platelet aggregation in patients with coronary artery disease. This was a double blind randomised study. Sample population consisting of 35 patients, were admitted at Lady Reading Hospital, Peshawar, for the management of coronary artery disease. Baseline platelet aggregation of all these patients was measured. These patients were divided in two groups randomly. Group-A consisting of 18 patients was given brand 'A' clopidogrel 600 mg, while Group-B consisting of 17 patients was give brand 'B' of clopidogrel 600 mg. The platelet aggregation of both groups was then measured at baseline, and at 2, 4, and 6 hours after taking the loading dose of 600 mg. Platelet aggregation time at baseline in Group-A was 2.61 +/- 2.28 sec. and in Group-B it was 2.24 +/- 1.52 sec. [p=0.57]. After 2 hours of clopidogrel administration in Group-A the platelet aggregation time was 1.44 +/- 1.58 sec. and in Group-B it was 1.53 +/- 1.107 sec. [p=0.85]. Platelet aggregation time after 4 hours in Group-A was 0.28 +/- 0.57 sec. and in Group-B 1.06 +/- 1.03 sec. [p=0.009], and after 6 hours it was 0.00 +/- 0.00 sec. in Group-A and in Group-B it was 0.59 +/- 0.71 sec. [p=0.001]. The two brands of clopidogrel had a significant difference in their effect on inhibition of platelet aggregation. Different brands of clopidogrel may not be equally effective

Frequency and predictors of renal artery stenosis in patients with coronary artery disease

Renal artery stenosis [RAS] is a common finding in patients undergoing coronary angiography. We designed this study to look for the frequency and any predictors of renal artery stenosis in patients with coronary artery disease [CAD]. A total of 201 consecutive patients with CAD confirmed by coronary angiography underwent an abdominal aortogram in the same sitting to screen for RAS. Patient demographics and co-morbidities were analysed for any association with RAS. Forty-one of the patients were female [20.4%]; ninety patients were hypertensive [44.8%]; 49 patients [24.4%] were smokers; 19 patients [9.5%] had renal insufficiency; 88 patients [43.8%] had high cholesterol levels; 44 patients [21.9%] were diabetic. Thirty-two patients [15.9%] had single coronary artery disease, 59 patients [29.4%] had two vessel disease, and 110 patients [54.7%] had three vessel disease. Significant renal artery stenosis [>/= 0.50% stenosis] was present in 26 patients [12.9%]. Among the variables studied, only female gender was found to be associated with a higher frequency of renal artery stenosis [24.39% vs 10.0%, p=0.01]. The frequency of renal artery stenosis in patients with coronary artery disease is 12.9%. Female gender is associated with a higher frequency of renal artery stenosis in patients with CAD