ABSTRACT
OBJECTIVES: Cardiogenic shock (CS) is still the leading cause of in-hospital mortality in patients presenting with acute myocardial infarction (AMI). The aim of this study was to determine the in-hospital mortality and clinical outcome in AMI patients presenting with CS in a tertiary hospital in Oman. METHODS: This retrospective observational study included patients admitted to the cardiology department between January 2013 and December 2014. A purposive sampling technique was used, and 63 AMI patients with CS admitted to (36.5%) or transferred from a regional hospital (63.5%) were selected for the study. RESULTS: Of 63 patients, 73% (n = 46) were Omani and 27% (n = 17) were expatriates: 79% were male and 21% were female. The mean age of patients was 60±12 years. The highest incidence of CS (30%) was observed in the 51-60 year age group. Diabetes mellitus (43%) and hypertension (40%) were the predominant risk factors. Ninety-two percent of patients had ST-elevation MI, 58.7% patients were thrombolysed, and 8% had non-ST-elevation MI. Three-quarters (75%) of CS patients had severe left ventricular systolic dysfunction (defined as ejection fraction <30%). Coronary angiogram showed single vessel disease in 17%, double vessel disease in 40%, and triple vessel disease in 32% and left main disease in 11%. The majority of the patients (93.6%) underwent percutaneous coronary intervention (PCI), among them 23 (36.5%) underwent primary PCI. In-hospital mortality was 52.4% in this study. CONCLUSIONS: CS in AMI patients presenting to a tertiary hospital in Oman have high in-hospital mortality despite the majority undergoing PCI. Even though the in-hospital mortality is comparable to other studies and registries, there is an urgent need to determine the causes and find any remedies to provide better care for such patients, specifically concentrating on the early transfer of patients from regional hospitals for early PCI.
ABSTRACT
Potassium bromate (KBrO3) cardiotoxicity is not widely recognized, in spite of its well known oxidative cell and tissue damage. The wide exposure to KBrO3 in food and water necessitates finding of a simple and available antidote for its hazards like vitamin C. There are growing evidences that the regulation of redox reactions in cells is intimately tied to the levels of antioxidants. As the heart is highly vulnerable for oxidative damage, left ventricle muscle was the spotlight of our study. For this purpose 20 adult male albino rats were categorized into four groups (five rats each). Group 1 served as control; group 2 received 30 mg/kg/day vitamin C for 4 weeks. Group 3 was injected intraperitoneally with KBrO3 20 mg/kg/dose twice weekly for 4 weeks, and group 4 received both vitamin C and KBrO3 in the same scheme. Heart specimens were processed for various histological examinations. Sections from KBrO3 treated animals showed focal disruption of cardiac myocytes, deeply stained nuclei and dilated congested blood vessels. Ultrastructurally, irregular indented nuclei, focal lysis of the myofibrils and swelling of mitochondria were also observed. In contrast, minimal changes were observed in rats treated concomitantly with both vitamin C and KBrO3. Caspase 3 immunohistochemical reaction was nonsignificantly increased in group 3 cardiomyocytes. Semiquantitative morphological mitochondrial scoring and statistical analyses revealed significant changes between the studied groups. Finally, KBrO3 induced structural changes in rat cardiac muscle could be ameliorated by concomitant treatment with vitamin C.
