Background The aim of this study was to determine the predictive value of the Global Registry of Acute Coronary Events (GRACE) score for predicting in-hospital and 6 months mortality after non-ST elevation acute coronary syndrome (NSTE-ACS). Results In this observational study, 300 patients with NSTE-ACS of age more than 30 years were included; 16 patients died during the hospital stay (5.3%). Of 284 patients at 6 months assessment, 10 patients died (3.5%), 240 survived (84.5%), and 34 were lost to follow-up (12%) respectively. In high risk category, 10.5% of the patients died within hospital stay and 11.8% died within 6 months (p = 0.001 and p = 0.013). In univariate analysis, gender, diabetes mellitus, family history, smoking, and GRACE score were significantly associated with in-hospital mortality whereas age, obesity, dyslipidemia, and GRACE were significantly associated with 6 months mortality. After adjustment, diabetes mellitus, family history, and GRACE score remained significantly associated with in-hospital mortality (p ≤ 0.05) and age remained significantly associated with 6 months mortality. Conclusion GRACE risk score has good predictive value for the prediction of in-hospital mortality and 6 months mortality among patients with NSTE-ACS.

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Objectives The Zwolle risk score (ZRS) has been considered to be a useful tool for the systematic evaluation of patients for early discharge after primary percutaneous coronary intervention (PCI). Therefore, aim of this study was to evaluate the clinical utility of ZRS for the same-day discharge strategy after primary PCI at a tertiary care cardiac center of Karachi, Pakistan. Methods This study was conducted at a tertiary care cardiac center between August 2019 and July 2020. Patients discharged within 24 h (same-day) of the primary PCI procedure were included. Patients were stratified as high- and low-risk based on ZRS score; low-risk (≤3) and high-risk (≥4). All patients were followed during 30-days post-procedure period for major adverse cardiac events (MACE). Results Out of 487 patients, 83.2% (405) were male and mean age was 54.6 ± 10.87 years. Mean ZRS was 2.34 ± 1.64 with 16.0% (78) patients in high-risk (≥4) group. 30-days MACE rate was observed to be 5.3% (26) with significantly higher rate among high-risk patients as compared to low-risk patients 12.8% (10) vs. 3.9% (16); p = 0.004 respectively with OR of 3.61 [1.57–8.29]. The area under the curve (AUC) of ZRS for prediction of 30-day MACE was 0.67 [95% CI: 0.58–0.77], ZRS ≥4 had sensitivity of 38.5% and specificity of 85.2% with AUC of 0.62 [95% CI: 0.50–0.74] for prediction of 30-day MACE. Conclusion ZRS showed moderate discriminating potential in identifying patients with high-risk of MACE at 30-day after same-day discharge after primary PCI.

ObjectiveKnowledge regarding the short-term outcomes after same-day discharge (SDD) post primary percutaneous coronary intervention (PCI) is lacking. In this study, we evaluated 1-year major adverse cardiovascular events (MACE) among SDD patients after primary PCI.Design1-year follow-up analysis of a subset of patients from an existing prospective cohort study.SettingTertiary care cardiac hospital in Karachi, Pakistan.ParticipantsConsecutive patients, from August 2019 to July 2020, with ST segment elevation myocardial infarction who had undergone primary PCI with SDD (within 24 hours) after the procedure by the treating physician and with at least one successful follow-up up to 1 year.Outcome measureCumulative MACE during follow-up at the intervals of 1 week, 1 month, 6 months and 1 year.Results489 patients were included, with a gender distribution of 83.2% (407) male patients and a mean age of 54.58±10.85 years. Overall MACE rate during the mean follow-up duration of 326.98±76.71 days was 10.8% (53), out of which 26.4% (14/53) events occurred within 6 months of discharge and the remaining 73.6% (39/53) occurred between 6 months and 1 year. MACE was significantly higher among patients with a Zwolle Risk Score (ZRS) ≥4 at baseline, with an incidence rate of 21.9% (16/73) vs 8.9% (37/416; p=0.001) in patients with ZRS≤3 (relative risk 2.88 (95% CI 1.5 to 5.5)).ConclusionA significant burden of short-term MACE was identified among SDD patients after primary PCI; most of these events occurred after 6 months of SDD, mainly among patients with ZRS≥4. A systematic risk assessment based on risk stratification modalities such ZRS could be a viable option for SDD patients with primary PCI.

Objectives Primary percutaneous coronary intervention (PCI) remains recommended reperfusion therapy for patients with acute ST-elevation myocardial infarction. This study aimed to evaluate the short-term major adverse cardiac events (MACE) and their determinants among patients who underwent primary PCI at a tertiary care cardiac center of Karachi, Pakistan. Methods A cohort of patients who underwent primary PCI were followed for the MACE. Multivariable Cox-regression analysis was performed with backward conditional variable selection and hazard ratio (HR) along with 95% confidence interval (CI) were obtained. Results A total of 1150 patients were included, of which follow-up was successful in 95.8% (1102) and median follow-up duration was 6.1 [6.9–5.1] months. MACE were observed in 210 (19.1%) patients with 14.2% (157) all-cause mortality, 5.4% (60) cardiac mortality, 0.7% (8) stroke, 3.6% (40) re-hospitalization due to heart failure, and 6.1% (67) myocardial infarction requiring revascularization. Independent predictors of short-term MACE were found to be admission glucose ≥200 mg/dL (1.66 [1.25–2.21]), serum creatinine ≥1.5 mg/dL (1.52 [1.02–2.27]), intubation (2.81 [1.98–4.00]), history of PCI (2.06 [1.45–2.93]), history of cerebrovascular accident (2.64 [1.34–5.2]), left ventricular end-diastolic pressure ≥20 mmHg (1.81 [1.3–2.51]), triple vessel diseases (1.43 [1.08–1.9]), culprit left main or proximal left anterior descending artery (1.77 [1.32–2.35]), pre-ballooning (2.14 [1.2–3.82]), and thrombus grade ≥4 (2.21 [1.51–3.24]). Conclusions A significant number of individuals undergone primary PCI are still vulnerable to subsequent short-term MACE, hence, systematic follow-up and early risk stratification should be considered as an integral part of STEMI management protocol specially for patients with high-risk features as highlighted herein.

Objectives: Prognostic importance of left ventricular end-diastolic pressure (LVEDP) is well established, hence, it is important to understand the factors associated with increased LVEDP for individualized risk stratification of ST-segment elevation myocardial infarction (STEMI) patients. There is dearth of data regarding clinical associates of elevated LVEDP, therefore, the purpose of current study was to evaluate the clinical indicators and phenotype of elevated LVEDP in STEMI patients undergoing primary percutaneous coronary intervention (PCI). Methodology: This descriptive observational study included patients diagnosed with STEMI and undergone primary PCI. LVEDP was measured using a fluid-filled pig-tail catheter before reperfusion but after angiography. Elevated LVEDP was taking as >25 mmHg. Results: A total of 498 patients were included, 23.7% (118) were female patients and mean age was 53.7 ± 11.7 years. Distribution of LVEDP was ≤15 mmHg in 48% (239), 15-25 mmHg in 42% (209), and >25 mmHg in remaining 10% (50) of the patients. Elevated LVEDP was found to be associated with increased heart rate (HR) with adjusted odds ratio of 1.05 [1.02-1.08], decreased systolic blood pressure (SBP) (0.95 [0.9-0.99]), Killip class II or high (9.36 [3.38-25.9]), and hypertension (4.63 [1.55-13.82]). Conclusion: Hemodynamic instability at presentation such as elevated HR, reduced SBP, higher Killip class and hypertension are the key indicators of elevated LVEDP.

Malignant multi-vessel coronary vasospasm is a rare life threatening condition, presentation like myocardial infarction (MI), arrhythmias, and cardiogenic shock (CS). We report a case of IWMI complicated by CS, angiogram shows diffuse multi-vessel coronary artery spasm. Intracoronary nitroglycerine showing improving spasm in culprit vessel RCA and distal RCA stented with excellent result. This case of early diagnosis of coronary artery spasm to prevent the occurrence of MI, arrhythmias and sudden cardiac death as it is one the rare cause. It also highlighted the role of intracoronary nitroglycerine in relieving diffuse multi-vessel vasospasm in hemodynamically unstable patient.

Objectives: The objective of this study was to determine the frequency of non-compliance to treatment and common precipitating factors in stage C heart failure (HF) patients at a tertiary care cardiac hospital of Karachi, Pakistan. Methodology: This descriptive cross-sectional study was conducted at a tertiary care cardiac center of Karachi, Pakistan. Required number of consecutive patients of either gender between 18 to 75 years of age who were diagnosed with stage C HF were included in this study. Data for the study were collected on a pre-defined proforma consisted of demographic characteristics (gender, age), clinical factors, and precipitants of decompensation of HF (duration of disease, non-compliance to the treatment, infection, arrhythmias, uncontrolled hypertension, and anemia). Results: A total of 114 patients with stage C HF were included. Mean age was 56.7 ± 9.9 years with 34.2% (39) patients above 60 years of age. Male patients were 51.8% (59) of the total sample and median duration of disease was 36 [20 to 60] months. Non-compliance to the HF treatment was observed in 48.2% (55), while among other precipitants, infection was observed in 21.9% (25), arrhythmias in 20.2% (23), uncontrolled hypertension in 13.2% (15), and anemia in 18.4% (21). Conclusion: A significant proportion of stage C HF patients were found to be non-adherent to the prescribed treatment. The most commonly observed triggering factor was infection followed by arrhythmias. Routine practice must include an ongoing assessment of compliance to the treatment and lifestyle modifications among HF patients for the proper counseling of non-complying individuals.