A nine-year-old Bangladeshi male with a body mass index 16.5 kg/m(2) presented with progressive tuberous xanthomata on both auricles, elbows, gluteal regions and legs since birth. His father, paternal and maternal grandfather had xanthelasma, however, the siblings had none. Examination of the cardiovascular system was otherwise normal. Laboratory investigations were performed on several occasions since he was 4 years of age and revealed extreme dyslipidaemia with very high total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoprotein B (Apo-B) and lipoprotein(a), and low apolipoprotein-A (Apo-A) levels. Repeated combination of lipid lowering agents with cholestyramine, atorvastatin and ezetimibe were virtually ineffective in improving the lipid profiles. Supplementation therapy with niacin also had no effect. In view of the unavailability in Bangladesh of lipid apheresis, the cornerstone of therapy, the management of the case becomes complicated.
Background: Several studies has shown that impaired renal function might be an important predictor of adverse cardiovascular events in patient with ST elevated myocardial Infarction (STEMI) undergoing primary percutaneous intervention (pPCI). Exact data on clinical impact of baseline or admission serum creatinine level of STEMI patient undergoing pPCI in our patient population not well established. Therefore, we have carried out this non-randomized study to see the effects of S. creatinine level on major adverse cardiovascular outcomes among STEMI patient undergoing pPCI.
Methods: Patients were enrolled in this observational non-randomized prospective cohort between November 2017-July 2019, who were presented into our emergency department with acute onset of severe chest pain or angina with ECG evidenced of acute ST elevated myocardial infarction. Total 137 patient (F 12; Male 125) were enrolled in this study.
Results: Out of 137 patients, female :12 (8.75%) vs Male: 125 (91.2%). Among, these patient females were more obese (BMI: Female 27.0 ± 2.2 vs male 25.4 ± 4.9) and developed CAD in advance age (Female 59.1 ± 14.5 vs Male 53.4 ± 10.5). Among the 137 patients, 89 (65%) were dyslipidemia, 72 (52.6%) were hypertensive, Diabetic 66(48%), Smoker 70 (51%) and FH positive for CAD were 31 (22.6%). According to the involvement of myocardium infarction, STEMI diagnosis of Anterior MI were 48.9% (n=67) and Inferior MI 51.1% (n=70). An elevated serum creatinine level was defined as creatinine >1.2mg/dl. Based on baseline serum creatinine level, patients were divided into group-A and Group-B. In Group-A. Total 68 patients have S. Creatinine level <1.2 and in Group-B, 69 patients have S. Creatinine level >1.2. Anterior MI were higher in group -B patient than Group-A; Ant MI as 35 (50.4%) vs 31(45.6%), Inf MIL: 34 (49.35) vs 34 (50%), Shock 11 (15.9%) vs 6 (8.8%0, CHB 4 (5.8%) vs 4 (5.9%), Death 12 (17.4%) vs 2 (2.9%) and LVF 5(7.2%) vs 1(1.5%) with 7 days in-hospital stay after primary PCI. Territory wise involvement of vessel in Group-B patient has more involvement of LAD 35 (50.7%) and Group-A has RCA 26(38.2%).
Conclusion: In this present study, we found, that in acute STEMI patients, baseline higher serum creatinine level is associated with more AMI related complications and death than in lower serum creatinine level. Thus, we may conclude that baseline admission serum creatinine level may be an important predictor for both in-hospital and 12-month survival outcomes in STEMI patients undergoing pPCI.
Cardiovasc. j. 2020; 12(2): 135-142
Background: Coronary artery disease (CAD) in Bangladeshi population is diffuse in nature with small caliber arteries. Now a day, these are treated, by PCI with stent deployment, often multiple in a single coronary artery. However, long term data on In-stent re-stenosis (ISR) in multiple or overlapping stent in single coronary artery in these patients is not yet available. Therefore, the aim of our present study was to assess long-term outcome of stent patency or the development of ISR of varieties stent in single vessel territory. Methods: Patients were prospectively selected from, who underwent coronary angiogram at our hospital for further evaluation of their previous PTCA in the 3-36 months preceding the study for the quantifying period of 2007-2011. Total 51 patients (male: 42, Female: 9) who had multiple stents in one coronary artery were included in this study. Average age was Male: 57; Female:61. Average study period was 3.1 ± 2.4yrs. Results: Our results show that, among the total studied population 82.4% (42) were male and 17.6% (9) were female. Total 114 stent were deployed in 54 vessels of 51 patients. Territory wise distribution of deployed stent was LAD 52(45.6%), RCA 42 (36.8%) and LCX 20(17.5%). Stent used were BMS 45(39.5%), DES 69(60.5%). Re-look Coronary Angiogram (CAG) revealed that Significant ISR (ISR>60%) developed in BMS 8(17.8%) and DES 8(11.5%). Among the different DES the development of significant ISR were in Sirolimus 1(3.2%), Paclitaxel 4(16%), Everolimus 3 (30%). Conclusion: Our study has shown that deployment of multiple stents in a single artery territory (either separately or as overlapping) is safe and has reasonably lower degree of ISR, even when BMS was used. As a whole BMS shows higher degree of ISR than to DES for an average period of follow up of 3.1 yrs. DOI: http://dx.doi.org/10.3329/cardio.v5i2.14319 Cardiovasc. j. 2013; 5(2): 154-159
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