This study was carried out to analyze risk factors and short-term clinical outcomes in different age groups of Indian patients with ST-elevation myocardial infarction who underwent percutaneous coronary intervention. This prospective, non-randomized, and observational study was carried out at a tertiary care hospital. The patients who were treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction at study center from December 2011 to September 2012 were included in the study. Study population is divided into three groups: Group-I consisted of patients with age ≤ 40 years, Group-II consisted of patients with age between 41 -60 years and Group-III consisted of patients with age > 60 years. The primary end-point of the study was occurrence of major adverse clinical outcomes which were a composite of death, reinfarct, repeat percutaneous coronary intervention, major bleeding and emergency coronary artery bypass grafting at 30-day follow-up. A total of 200 patients with ST-elevation myocardial infarction who underwent percutaneous coronary intervention were included in the study. Among study population, 10 (5%) patients constituted Group-I, 96 (48%) patients constituted Group-II and 94 (47%) patients constituted Group-III. Diabetes (0% vs. 35.4% vs. 43.6%) and hypertension (10% vs. 35.4% vs. 44.7%) were more prevalent in Group-III as compared to Group-II and Group-I. The prevalence of single vessel disease was significantly higher in the Group-I compared to Group-II and Group-III (80% vs. 41.66% vs. 17%). At 30-day clinical follow-up, the rate of occurrence of major adverse clinical outcomes in Group-I, Group-II and Group-III is 0%, 2% and 5.4%, respectively. The young ST-elevation myocardial infarction patients had lower incidences of diabetes and hypertension compared with elderly patients. The young age group had more favorable inhospital and 30-day clinical outcomes.
Background: Around 7 million patients undergo percutaneous interventional vascular procedures worldwide annually and this number is expected to escalate further in coming years. The aim of this study was to analyse immediate and short term follow up of patients with acute coronary syndrome (ACS) who had undergone percutaneous coronary intervention (PCI) through femoral route and closure with vascular closure device. Methods: This was non randomised, single centre study and was conducted in a tertiary care institution between January 2013 to June 2014 with 62 ACS patients undergoing femoral access invasive cardiac interventional procedure. Perclose A-T system was used in all patients as closure device. Patients were followed up to 15 days of clinical evaluation. Results: Of 62 ACS patients, 40 (64.5%) were with non-ST elevation myocardial infarction and 22 (35.5%) patients had history of unstable angina. The perclose device achieved closure within 5 to 10 minutes and all patients were kept in hospital stay for 2 to 3 days. There was one major complication of continuous bleeding, one incidence of small pseudo aneurysm, and two incidences of small hematomas with need of blood transfusion. Conclusions: This study demonstrates the ability of arterial closure device to safely and effectively achieve arterial closure in patients undergoing percutaneous intervention for ACS. Manzil AS et al. Int J Res Med Sci. 2017 Mar;5(3):778-781 International have improved patient comfort, and shortened the time needed for hemostasis, ambulation and thereby discharge. Keywords6 Several VCDs are available with different mode and method of closure (intravascular or extravascular), time of hemostasis, time of ambulation and type of healing (primary or secondary). 7 But there was paucity of data to support use of arterial closure devices in patients with ACS. Therefore, we analysed immediate and short term follow up of patients with ACS who had undergone PCI through femoral route and closure with vascular closure device. METHODSThis was non randomised, single centre study and was conducted in a tertiary care institution between January 2013 to June 2014 with 62 ACS patients undergoing femoral access invasive cardiac interventional procedure. Patients were selected between the ages of 18 and 75 years who were scheduled emergency coronary interventional procedures. The target vessel lumen diameter was at least 6 mm and 7 Fr arterial sheaths were utilised.Patients were excluded if they had a body mass index (BMI) of <20 or >40, previous femoral arterial access within 3 months, any bleeding diathesis or anaemia. ST elevation myocardial infarction (STEMI), Cardiogenic shock, hemodynamic unstable patients were excluded. All patients underwent iliac and femoral angiogram prior to closure. Outcomes evaluated include time to hemostasis, time to ambulation, rates of vascular complications. Vascular complications that were evaluated include major complications including vascular injury requiring surgical repair, need for blood transfusio...
BACKGROUND The aim of the study is to evaluate the efficacy and safety of thrombectomy with catheter-directed thrombolysis in patients with massive or submassive Pulmonary Embolism (PE) and to study the clinical profile of these patients at one year follow up. MATERIALS AND METHODS This was a single centered prospective study that included 15 patients with acute massive or submassive pulmonary embolism who underwent pulmonary thrombectomy with catheter-directed thrombolysis (intrapulmonary half-dose reteplase) between January 2013 and March 2015. The patients were followed up to one year. RESULTS Of total 15 patients, 80% of patients were females. Five and ten patients had massive and submassive PE, respectively. At one year follow-up, there was improvement in systolic blood pressure, heart rate, respiratory rate, peripheral capillary oxygen saturation, pulmonary arterial pressure and right ventricular function in patients with massive as well as submassive PE. One year mortality rate was 6.6% and there was one major and one minor incidence of bleeding. Haemodynamic improvement was observed in 93.3% patients. CONCLUSION The study concludes that pharmacomechanical therapy, i.e. the use of pigtail catheter followed by intrapulmonary half-dose thrombolysis using bolus reteplase results in favourable one year outcomes in patients with massive or high-risk submassive pulmonary embolism.
Background: This study was intended to evaluate clinical outcomes in diabetic patients who underwent triple vessel angioplasty for treatment of triple vessel coronary artery disease. Methods: This was an observational, single centred study, which included a total of 27 diabetic patients who underwent triple vessel angioplasty at a tertiary care hospital from May 2010 to July 2012. The study describes the clinical profile of the patients and a moderate term clinical follow-up to reassess the symptoms, functional status and left ventricular function by history, electrocardiogram, echocardiogram, and treadmill test. Mortality and morbidity were considered as end-points of the study. Results: Of 27 patients, 18 were males, and 55.6% were hypertensive. 70.4% of patients had normal left ventricular function. Total number lesions were 97 and the total stents implanted were 85. Event-free survival rate was 92.6% at a mean follow-up of 20.3 months. Overall 100% continued success was obtained with triple vessel angioplasty. Conclusion: Triple vessel angioplasty can be applied as favourable therapy as an alternative to surgical revascularization in selected diabetic patients. However, larger studies with long-term follow-up would warrant the effectiveness of triple vessel angioplasty in such patients. Key words: Angioplasty, Coronary Artery Disease, Diabetes, Multivessel Disease, Stents. Ashraf Safiya Manzil INTRODUCTIONGlobally, the prevalence of diabetes mellitus has been escalating since decades in affecting millions of people. 1 Diabetes poses to be a risk factor for cardiovascular disease, contributing to higher rates of myocardial infarction and cardiovascular mortality.2,3 Coexistence of diabetes and coronary artery disease (CAD) has been associated with increased mortality and morbidity, because diabetic patients have allied with larger burden of atherogenic risk factors, like hypertension, obesity, dyslipidemia, insulin resistance, elevated levels of plasma fibrinogen, 4 enhanced platelet reactivity and reduced responsiveness to antiplatelet agents. 5,6 Moreover, literature suggests that diabetics have smaller coronary vessel diameter, diffused lesions, and probably a dissimilar restenotic cascade than nondiabetic patients, thus being highly liable to atherosclerosis and having a greater requirement for undergoing repeat revascularizations, 7,8,9 thus leading to poor prognosis in such patients. 3,4,5,6,7,8,9,10 Optimal approach for treating multivessel coronary disease has been controversial 11 and triple vessel stenosis in diabetic patients make the matter worse. Though coronary artery bypass surgery (CABG) had been the conventional treatment for triple vessel disease, 12,13,14 due to presence of some limitations like angiographic features related to the extent, location, and nature of CAD, as well as geographic, demographic and clinical factors; preference of approach shifts to percutaneous coronary intervention (PCI) instead of CABG. 15 In addition, some patients have been poor candidates for CABG, lik...
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