Background: Aim of this study was to perform quantitative evaluation of high thrombus burden (Grade ≥4) as an independent predictor of slow/no reflow phenomenon during primary percutaneous coronary interventions (PCI) of patients with ST-segment elevation myocardial infarction (STEMI). Methods: In this analytical cross-sectional study we included consecutive patients who have undergone primary PCI for STEMI at a tertiary care cardiac center of the Pakistan. High thrombus burden was defined as angiographic thrombus grade ≥ 4. The thrombolysis in myocardial infarction (TIMI) flow rate < III was defined as slow/no reflow phenomenon. Results of multivariate logistic regression analysis for slow/no reflow phenomenon were reported as odds ratio (OR). Results: This analysis included 747 patients, 78.2% (584) patients were male and mean age was 55.82±11.54 years. High thrombus burden was observed in 68.1% (509) of the patients. Slow/no reflow phenomenon was observed in 33.6% (251) which was more common among patients in high thrombus burden group, 39.7% (202/509) vs. 20.6% (49/238); p<0.001. Adjusted OR of thrombus Grade ≥ 4 was 2.33 [1.6 -3.39]; p<0.001. Other significant variables were female gender (1.51 [1.01 -2.27]; p=0.045), left ventricular end-diastolic pressure (LVEDP) ≥20 mmHg (2.34 [1.69 -3.26]; p<0.001), total lesion length ≥ 20 cm (1.54 [1.09-2.16]; p=0.014), and neutrophil count ≥ 8.8 cells/µL (1.72 [1.22 -2.43]; p=0.002). Conclusion: High thrombus burden (Grade ≥ 4) is a significant and an independent predictor of the slow/no reflow phenomenon. While predicting slow/no reflow phenomenon, thrombus burden should be given due importance along with other significant factors such as gender, LVEDP, lesion length, and neutrophil counts.
Objectives: This study was designed to compare the in-hospital outcomes of primary PCI with export vs. primary PCI with the balloon in patients with total occlusion. Methodology: Consecutive patients with STEMI undergoing primary PCI with TA and pre-balloon dilatation were recruited in 1:1 ratio and post-procedure in-hospital mortality and complication rate (slow flow/no-reflow, contrast-induced nephropathy (CIN), and arrhythmias) were compared. Patients in the TA group were further stratified based on export time (time from onset of chest pain to the use of export) as ≤ 6 hours or > 6 hours. Results: A total of 200:199 patients were recruited in export and balloon group. Overall complications were significantly higher in balloon group, 39.7% (79/199) vs. 23.0% (46/200); p<0.001, which included slow flow/no-reflow (24.6% vs. 14.5%; p=0.005), CIN (10.1% vs. 4.5%; p=0.022), and arrhythmias (14.6% vs. 5.5%; p=0.006) with in-hospital mortality rate of 3.0% (6/200) vs. 6.0% (12/199); p=0.153. Upon stratifications, outcomes were more favorable when export time was ≤ 6 hours as compared to > 6 hours with mortality rate of 0% vs. 6.3%; p=0.010 and complication rate of 19.2% vs. 27.1%; p=0.187. Conclusion: TA in patients with total occlusion was associated with lesser complications and relatively better mortality benefits. The benefits of TA were directly associated with export time. Therefore, timely use of export can be considered in patients with total occlusion.
Funding Acknowledgements Type of funding sources: None. Background The risk stratification scores are very helpful to categorize high risk patients to plan future management. Therefore, in this study we compared the predictive value of TIMI and GRACE score for predicting in-hospital outcomes after non-ST elevation acute coronary syndrome (NSTE-ACS). Methods This study included prospectively recruited cohort of patients presented to a tertiary care cardiac center in Pakistan who were diagnosed with NSTE-ACS. GRACE and TIMI score were obtained and in-hospital mortality was recorded. The receiver operating characteristic (ROC) curves analysis was performed and area under the curve (AUC) was obtained as indicative of predictive value for both scores. Results A total of 300 patients were included, out of which 76.7%(230) were male and mean age was 58.04 ± 10.71 years. Risk profile comprises of 84.3%(253) hypertensive, 42.0%(126) diabetic, 27.3%(82) smokers, 9.0%(27) obese, 15.3%(46) dyslipidemic, and 31%(93) with sedentary lifestyle. Mean GRACE and TIMI score were 120.19 ± 33.17 and 3.18 ± 0.85 respectively. In-hospital mortality rate was 5.3%(16). AUC for the GRACE score was 0.851 [0.767 - 0.934] with the optimal cutoff value of 150 with sensitivity of 68.8% and specificity of 84.9%. The AUC for the TIMI score was 0.781[0.671 - 0.891] with the optimal cutoff value of 4 with sensitivity of 75.0% and specificity of 67.6%. Conclusion The GRACE score has high discriminating strength for predicting in-hospital mortality after NSTE-ACS. GRACE score should be used as risk stratification modality in clinical decision making for the management of NSTE-ACS.
Background: Depression is very common among individuals recovering from a chronic illness with long-term or recurrent hospitalization. Post-myocardial infarction patients are at risk of developing depression and is considered to be a risk for elevated mortality. Aims and Objective: To determine the frequency of depression among various ethnic groups of patients post primary percutaneous coronary intervention for acute myocardial infarction. Material and Methods: �A cross-sectional study was conducted at the out-patients department of NICVD, Pakistan for a duration of six months from February 2021 to July 2021. Total 256 patients aged between 18 to 85 years, were diagnosed with STEMI, and had undergone PCI were included in the study. Patients with prior diagnosis of CAD or had prior history of psychological problems were excluded from the study. Patients were interviewed for depression by using Beck's depression inventory (BDI). Patients scoring > 10 were labeled as having depression. Results: Out of 256 patients, 122 (48.8%) patients were screened positive for depressive symptoms.� Out of these, about 21.1% had mild depression, 16% had borderline clinical depression, 10.5% had moderate depression, while about 0.8% had severe depression. Age of 71 years and above, female gender, diabetes, hypertension, and sedentary lifestyle were all significantly correlated with increased risk of depression in post-MI patients with BDI scores of 17.64 � 7.9 (<0.0001), 13.54 � 7.53 (0.015), 14.47 � 7.61 (p<0.0001), 13.52 � 6.83 (p<0.0001), and 16.69 � 7.57 (p<0.0001), respectively. Conclusion: After percutaneous coronary intervention for MI, depression was found in almost half of the patients. However, as per our study, the risk for depression is independent of ethnic background.
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