Objectives: To determine the role of CHADS-VASc Score in predicting No Reflow phenomenon in STEMI patients undergoing primary PCI. Study Design: Analytical cross-sectional study. Place and Duration of Study: This study was carried out at a Tertiary Cardiac Care Center from Feb to May 2022. Methodology: A total of (n = 320) patients who underwent PPCI at Armed Forces Institute of Cardiology from 4th February to 3rd May 2022 were enrolled in this study. Patients were divided into 2 groups, Comparision group with no NRP and NRP group. Descriptive statistics was run to present the categorical data in frequencies and percentages and continuous data in Mean±SD. Chi square test was applied to compare both groups regarding categorical and continuous variables. CHADS-VASc score was also compared in both groups. Results: Out of (n=320) patients, 80(25%) patients developed NRP. Age, Diabetes, LV EF, history of stroke or TIA, peripheral arterial disease, TIMI thrombus grade, total stented length and CHADS-VASc score were found to be significantly associated with NRP. Binary logistic regression analysis revealed diabetes, LV EF, TIMI thrombus grade, total stented length and CHADSVaSc score to be independent predictors of NRP.ROC analysis revealed a cutoff CHADS-VaSc score of 3 to be a good predictor of NRP (sensitivity 65% and specificity 82%). Conclusion: CHADS-VASc score can be an important pre PCI tool to predict NRP during primary PCI.

The no reflow phenomenon is a feared complication in Percutaneous Coronary Intervention (PCI) procedures including elective as well as primary PCI (Percutaneous Coronary Intervention), and results in worse prognosis. A number of etiological factors are involved in pathogenesis of no reflow phenomenon. These include distal athero embolization, ischemic and reperfusion injury, microvascular spasm and endothelial dysfunction. The treatment of no reflow depends on underlying mechanism and includes pharmacological as well as non-pharmacological interventions. Pharmacological agents include vasodilators like adenosine, sodium nitroprusside, verapamil, in addition to adrenaline (intracoronary) and, GpIIa/IIIb inhibitors. Non pharmacological measures include mechanical thrombus aspiration. Among pharmacological agents, Verapamil is usually the least preferred agent because of its negative ionotropic effect. Here, we describe a case of refractory no reflow in a patient undergoing primary PCI to right coronary artery (RCA), which was treated with a no. of pharmacological agents as well as aspiration thrombectomy but without much success and finally responded to intracoronary verapamil.

Objective: To evaluate the long-term clinical results for a one-stent (1S) strategy compared to a two-stent (2S) strategy in distal unprotected left main coronary artery (ULMCA) bifurcation disease. Study Design: Comparative Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology, Rawalpindi Pakistan, from Jan 2019 to Apr 2020. Methodology: 1-S approach was defined as stenting of the main vessel only and 2-S approach as stenting side branch and main vessel. Individual undergoing LMCA intervention were included via consecutive sampling in the study. Stent Crossover approach was used in 1-S technique; whereas, DK crush, culotte, and T-stenting approaches were employed in individuals who were treated with a 2-S approach. A composite of major adverse cardiovascular event (MACE) i.e., myocardial infarction, stroke or death and target lesion revascularization (TLR) were considered as primary end-point. Results: A sum of 110 individuals were inducted, 74 of them had stenting of left main bifurcation using a 1-S approach; and 36 patients underwent a 2-S PCI. Average age of the patients included in the study was 63.9±10.8 years. In 1 stent subset, the success rate of procedure was 99% whereas 100% success rate was seen in 2-S group. During the 2-year duration of follow up,frequency of MACE in single stent subset was (5.4%) whereas it was (13.8%, p=0.253) in the 2-S subset. Conclusion: When compared to 2-S approach of distal left main stenting, a 1-S strategy appears to demonstrate optimal clinical results and 2-year survival free of MACE. Choosing appropriate interventional strategy has proven prognostically significant; so, it demands mindful approach selection.

Objectives: Objective of this study was to find out the prevalence of risk factors for coronary artery disease in very important group of population who are expected to have sedentary lifestyle. Study Design: Cross-Sectional study. Setting: Faisalabad Institute of Cardiology, Faisalabad. Period: January 2015 to June 2017. Material & Methods: Officers from age of 25 years to 60 years and of either sex were enrolled in study. FLP, FBS, BP, weight and height were measured at FIC. Frequency of coronary artery disease risk factors including Diabetes, HTN, smoking, dyslipidemia, physical activity and obesity was noted considering diagnostic criteria. Results: Mean age was 40.86 ± 7.49, 84.4% (n=76) were male, 15.6% (n=14) were females, 11.1% (n=10) were diabetic, 88.9% (n=80) were non-diabetic, 4 were known case of ischemic heart disease with one having CABG. Smoking was present in 27.8%(n=25). Hypertension was found in 22.2%(n=20). LDL cholesterol was raised in 24.4%(n=22) officers. 46.7%(n=42) were having high BMI i.e.>25.  A high proportion was found to have sedentary lifestyle with 72.2%(n=65) being physically less active. Conclusion: Major conventional Risk factors for coronary artery disease are prevalent in young healthy judicial officers who were not patient of any significant disease.

ORIGINAL PROF-3713 ABSTRACT… Background: Due to increased risk of CAD and cardiovascular events, prediction of severity and/ or complexity of coronary artery disease (CAD) are valuable. Previously association between severity of CAD and total coronary artery calcium (CAC) score was not demonstrated but now there are lot of studies which have proven this association but still association between total CAC score and complexity of CAD is not well established. Objective: This study was conducted: (1) To investigate the association between coronary artery calcium (CAC) score and CAD assessed by CCTA. (2) To find which one of the two, CAD severity or complexity, is better associated with total CAC score in symptomatic patients having significant CAD. Study Design: Observational cross sectional study. Place and Duration: The study was conducted at Shifa International Hospital Faisalabad from March 2013 to June 2016. Materials and Methods: Total 195 consecutive patients of both gender age ≥20 years who was referred for CT angiography to our hospital and who fulfill the inclusion and exclusion criteria was included in the study. Before enrollment in the study all patients gave informed consent. Before CT angiography total CAC score was obtained by non-enhanced CT scans. Demographic characteristics of all patients were obtained. Regarding risk factors for CAD, history of hypertension, diabetes mellitus, family H/O ischemic heart disease and hyperlipidemia was noted. In all patients before CT angiography, Lab. investigations including complete blood count, fasting blood sugar, fasting lipid profile, blood urea and serum creatinine levels were obtained. Calcium scores were quantified by the scoring algorithm proposed by Agatston et al. All lesions were added to calculate the total CAC score by the Agatston method. Calcium scores were divided into the following categories: 0, 1-100, 101-400, and ≥400. The degree of stenosis was classified into four categories: (1) no stenosis, (2) minimal or mild stenosis (≤50%), (3) moderate stenosis (50%-70%), and (4) severe stenosis (>70%). CAD was defined when lumen diameter reduction was greater than 50% (moderate or severe stenosis). Results: Total 195 patients were studied. 136 (69.7%) were male and 59 (30.3%) were female. Mean age of study population was 52.8±10.38 years. 81(41.54%) patients had H/O chest pain, 11(5.64%) had H/O shortness of breath and 96(49.23%) presented with chest tightness. 104(53.33%) patients were hypertensive, 71(36.41%) were diabetic, 67(34.35%) had increased cholesterol level. In 57 (29.2%) there was no coronary artery disease, 58(29.7%) had mild CAD, 32 (16.4%) had moderate and 48 (24.6%) had severe coronary artery disease on CT angiography. Single vessel was involved in 38(19.5%) patients, 20(10.3%) had two vessel disease and triple vessel disease was present in 22(11.3%) patients. 104(53.3%) patients had zero calcium score. 44(22.6%) had CAC score between 1-100, 37 (19%) had CAC score between 101-400 and more than 400 CAC score was documented in 10 (5.1%) ...