BackgroundThe coronary slow flow phenomenon (CSFP) is an angiographic finding characterized by delayed distal vessel opacification in the absence of significant epicardial coronary stenosis. Although it is well-known to interventional cardiologists for approximately four decades, the etiopathogenesis still remains unclear.Aims and objectivesIn this study, we aimed to determine the clinical, demographic, risk factor and angiographic profile of patients with CSFP.MethodsClinical, demographic, risk factor and angiographic profile were recorded in all consecutive patients who had undergone coronary angiography between September 2016 and March 2017 and showed features of CSFP and a control group who showed normal coronary flow (NCF). The CSFP was diagnosed on the basis of the corrected thrombolysis in myocardial infarction frame count.ResultsCSFP was significantly more prevalent in male patients. Among the traditional risk factors, there was significantly more prevalence of hypertension (31.25% versus 6.67%, p < 0.001), dyslipidemia (40% versus 7.5%, p < 0.001) and history of tobacco use (47.5% versus 10.0%, p < 0.001) in CSFP patients as compared to NCF patients. On multivariable regression analysis hypertension, dyslipidemia, history of smoking and tobacco chewing were found to have independent association with CSFP. Acute coronary syndrome (ACS) was the most common mode of presentation in CSFP patients.ConclusionCSFP was relatively common among patients who presented with ACS. Hypertension, dyslipidemia, smoking and tobacco chewing can be considered independent risk factors for this phenomenon. Therefore, CSFP should be considered as a pathological entity and not an entirely benign condition.
A rare case of biventricular thrombi complicating acute myocardial infarction detected during echocardiography is described.
Background: This study was aimed to evaluate clinical and angiographic profile of patients undergoing percutaneous coronary intervention at the Department of Cardiology, Mathura Das Mathur (MDM) Hospital attached to Dr. Sampurnanand Medical College, Jodhpur.Methods: This study was hospital based prospective observational study conducted in the department of cardiology at MDM hospital. This study included 1166 patients who underwent percutaneous coronary intervention at cardiac cathlab of MDM hospital from January 2016 to April 2017. Procedural details noted included vascular access route, lesion characteristics, number of lesions intervened, stents used and periprocedural pharmacotherapy administered.Results: A total of 1166 patients (mean age- 56.3±10.4 years) with 76.5% male and 23.5% female were included in the study. Smoking and hypertension were the most common risk factors, present in 64% and 56% patients respectively. Diabetes mellitus and obesity were observed in 24.5% , 18.0% patients respectively. Anterior wall MI was the most common mode of presentation (36.2%). Single Vessel Disease (SVD) was the most common angiographic pattern observed in 62% patients; left anterior descending artery (LAD) was the most frequently involved vessel (65.9%); and type B lesions were most prevalent (48%). Most of the procedures were elective (61.4%) and femoral route was used in the majority (76%). Radial access was obtained in 24% of patients. Primary PCI was done in 6% of cases while pharmaco-invasive approach was adopted in 32.6% of patients. Drug eluting stents were deployed in 100% of the cases. The overall procedural success rate was 95.4%. Procedural mortality was nil and periprocedural complications occurred in 16.0% patients.Conclusions: This first PCI study from western Rajasthan provides an overview into the salient features of CAD among regional population and focus on the characteristics of PCIs performed with their outcomes.
Background: Heart disease is the leading cause of mortality in population above the age of 65 years. Severity and prevalence of coronary artery disease (CAD) increase with increasing age. Thrombolysis remains the standard of care in the management of acute ST-elevation myocardial infarction (STEMI) in developing countries like India where primary percutaneous coronary intervention (PCI) is still not possible in the majority of patients. The risks and benefits of thrombolytic reperfusion therapy among the elderly patients with STEMI is much less known. Authors aimed to evaluate the outcome and complications of thrombolytic therapy in elderly patients admitted with acute STEMI.Methods: The present observational study was done between January 2017 and January 2019 in the department of cardiology, Dr. S.N. Medical College, Jodhpur, India. It included a study group comprising 102 consecutive elderly patients who had acute STEMI and underwent thrombolytic therapy and a control group comprising 102 consecutive elderly patients who had STEMI who were not given thrombolytic therapy. Both groups were evaluated for an outcome (in-hospital mortality) and complications.Results: The overall in-hospital mortality was less in thrombolytic therapy group as compared to control group although not statistically significant (8.82% versus 14.70%, p=0.277). Similarly, in-hospital mortality was less in thrombolytic therapy subgroup A (age 66-74 years) as compared to control subgroup A (6.45% versus 10.75%, p=0.583) and also less in thrombolytic therapy subgroup B (age 75-85years) as compared to control subgroup B (12.50% versus 21.62%, p=0.445). Among the traditional risk factors, co-morbid conditions and complications, there was less prevalence of diabetes mellitus (4.90% versus 15.68%, p=0.021), hypertension (5.88% versus 6.86%, p=1.000), cardiogenic shock (8.82% versus 9.80%, p=1.000), left ventricular failure (LVF) (0.98% versus 3.92%, p=0.365) and atrioventricular (AV) block (0% versus 4.90%, p=0.245) but more acute kidney injury (AKI) (2.94% versus 0%, p=0.070) in thrombolytic therapy group patients as compared to control group patients. Cerebrovascular accident (CVA) did not occur in both group patients.Conclusion: Despite the higher prevalence of co-morbidities and high risk features in elderly patients of acute STEMI, timely thrombolysis is beneficial. A mortality benefit was seen in all groups suggesting net benefit regardless of increasing age up to the age of 85 years.
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