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Objectives: The aim behind this study was to scientifically correlate theglycosylated hemoglobin and lipid profile with the complexity of coronary artery disease. StudyDesign: Comparative hospital based study. Setting: Cardiology Department of Isra UniversityHospital Hyderabad. Period: Six months. Patients and Methods: 112 participants between theages of 25 to 80 years both male and female and undergoing their first coronary angiographywas included. Data were entered and analyzed by using Statistical Package for the SocialSciences version 20.0. Results: The mean age of patients was 54.16 years (9.74 ± SD) and thestudy subjects consisted of 76 males (67.86%) and 36 (32.14%) females. a total of 65 patients(58.0%) were presented between the ages of 41 – 60 years (middle aged group). The meanSYNTAX Score was 15.22. Patients with increased HbA1C (≥6.5%) and triglyceride levels (≥150mg/dl) and decreased HDL-C levels (≤40 mg/dl) were tend to have high Sx score. However,we did not find any significant relationship of SX score with total cholesterol and LDL-C levels.Conclusion: It was found that the trend of complexity of CAD increased with increasing age,high HbA1C, high LDL-C, high serum triglyceride, and low HDL-C levels.

Introduction: Acute coronary syndrome(ACS) is associated with activation ofplateletsand thecoagulationsystem which could influence the incidence of early stentthrombosis(EST).Stent thrombosis is a relatively uncommon phenomenon, yet it is a serious complication which often presents as an ST-segment elevation myocardial infarction (STEMI) and/or sudden cardiac death1,2.Stent thrombosis (ST) is an uncommon but life-threatening complication after percutaneous coronary intervention (PCI), frequently manifesting as acute coronary syndrome (ACS) or even cardiac death.Platelet activation and the heightening of the coagulation system play a major role in the pathogenesis of acute coronary syndrome (ACS) and might impact the occurrence of stent thrombosis in those patients who undergo stenting during ACS. Unfortunately, stent thrombosis (ST) is more frequent after stenting for STEMI than after elective stenting with both drug-eluting stents (DES) and baremetal stents (BMS). Objective: To determine the frequency of early subacute stent thrombosis after primary percutaneous coronary intervention in patients with STsegment elevation myocardial infarction Methodology: Study Design: Descriptive Case Series Setting: This study was conducted in NICVD Hospital, Karachi Subjects and Methods: Study was approved by hospital ethical review committee. All patients who fulfilled the inclusion criteria were included in the study. Pre-operatively a written consent was taken from each patient by the primary investigator of this study. All these patients were undergone primary PCI and stent either drug-eluting stents (coated with medication) or bare-metal stent was placed. These patients were observed for 24 hours for early subacute stent thrombosis. All the collected data were entered into the proforma attached at the end. Results: Mean ± SD of age was 55.56±12.24 with C.I (53.52------57.59) years. Mean ± SD duration of surgery was 33.48±9.26 with C.I (31.90------35.05) minutes. Out of 142 patients 103 (72.53%) were male and 39 (27.4%) were female. Frequency of early subacute stent thrombosis was found to be 4(2.82%). Conclusion: It is to be concluded that frequency of early acute stent thrombosis after primary PCI was found to be 2.82%.Patients presenting with STEMI who are hemodynamically unstable and have multivessel coronary disease undergoing coronary stenting during ACS, are at increased risk of EST. Keywords: Acute myocardial Infarction, Primary PCI, Early Subacute Stent, Thrombosis, STEMI

Objective: To evaluate the outcomes of transradial approach in terms of procedural failure in patients undergoing percutaneous coronary intervention. Methods: We have enrolled a total of 276 patients who consented for percutaneous coronary intervention through trans-radial approach at National Institute of Cardiovascular diseases, Karachi. Baseline and clinical data were collected in a structured questionnaire. Patients were assessed at the end of completion of PCI for the achievement of TIMI grade 3 flow by angiography under the supervision of experienced consultant having >5 years' experience of intervention. All the data entered and analysed using SPSS version 22.0. Results: Overall mean age of study subjects was 44.86±12.22 years, with range of 52 (18-70) years and among them 194 (70.28%) were males and 82 (29.71%) were females. The overall mean fluoro time was 10.95±4.83 minutes, with range of 22.1 (3.4-25.5) minutes. Our study's findings have shown no significant association of procedure failure was found with respect to gender, age, CRF, smoking, and obesity, p value <0.05. Significant association of procedure failure was observed in patients with hypertension, diabetes mellitus, family history of ischemic heart disease, hyperlipidemia and fluoro time >10 minutes. Conclusion: Transradial approach becomes the primary choice of vascular access for PCI. The transradial approach eliminates access site complications after PCI. Thus, patients discharge from hospital within 48 hours post-procedure and can mobilize within few hours post-procedure.

Objective: To determine the rate of adverse outcome in patients with at least five TIMI scores after primary percutaneous coronary intervention. Methods: We conducted this descriptive study at National Institute of Cardiovascular Diseases Karachi for six months. This study included 200 men and women with chest pain who presented to the emergency department with chest pain and ST-segment elevation myocardial infarction. PCI processes were executed by cardiologists, and any post-procedure adverse outcomes were noted throughout the hospital stay. Results: A total of 200 participants were involved, 167 (83.5%) being males, and 33 (16.5%) being females. There were 95 (47.5%) moderate risk cases and 105 (52.5%) high-risk cases based on the TIMI scores. In the survey of patient outcomes, death occurred in 18.5% of cases, heart failure was observed in 43 cases (21.5%), cardiogenic shock was observed in 27 cases (13.5%), and ventricular arrhythmia was observed in 44 (22%) cases. Practical Implication: This research on the outcomes of primary PCI in patients with a TIMI score of five or higher can provide valuable information for healthcare providers, leading to improved patient selection, enhanced treatment decision-making, tailored interventions, reduced morbidity and mortality rates, and increased cost-effectiveness in managing myocardial infarction cases. These practical implications can significantly benefit the community by improving patient outcomes and optimizing healthcare resource utilization. Conclusion: A TIMI risk score of five or higher can also identify patients who may have heart failure, cardiogenic shock, and ventricular arrhythmias. Keywords: Primaryipercutaneous coronary intervention, thrombolysis, myocardial infarction, score of five or higher.

Objective: The object of our research was to determine whether intra-aortic balloon pump-assisted PCI improved overall clinical outcomes during hospitalization, as well as to predict in-hospital mortality and cardiogenic shock. Methods: This retrospective study was carried out at National Institute of Cardiovascular Diseases Karachi. We enrolled 60 consecutive patients with a history of AMI complicated by cardiogenic shock. These patients underwent PCI with insertion of an IABP between 1st September 2019 and 28th February 2020. Patients with cardiogenic shock would have better survival if the IABP was inserted before PCI rather than after PCI was performed. The prospective study included 60 patients (33 patients received IABP before PCI, before and 27 after PCI) suffering from cardiogenic shock complicating acute myocardial infarction who underwent PCI with IABP. SPSS version 23.0 was used to analyze all the data. Results: Based on the type of treatment, we divided individuals into two groups in our study. The IABPs were inserted before PCI in 33 patients in group A, and the pumps were started after PCI in 27 participants in group B. It was significantly different regarding the 30-day mortality rate between IABP support after PCI and IABP-assisted PCI (59.2% versus 18.1%, respectively, p = 0.006). Among the entire study population, no reinfections or repeat PCI were reported. There was no significant difference between these two groups in the rates of emergency bypass surgery and cerebral vascular events. Practical Implication: This research study on in-hospital mortality among patients with acute coronary syndrome and cardiogenic shock treated with PCI and IABP has practical implications that benefit the community. It enhances patient outcomes, informs clinical decision-making, contributes to treatment guidelines and protocols, facilitates healthcare resource allocation, and inspires future research and innovation. Ultimately, the study aims to improve the quality of care provided to patients in this specific population, leading to reduced mortality rates and improved patient well-being Conclusion: This study concluded that PCI assisted by IABP results in a better outcome for patients with cardiogenic shock complicating acute myocardial infarction and a lower mortality rate compared to IABP after PCI. Keywords: In-hospital mortality, percutaneous coronary intervention, intra-aortic balloon pump.

Objective: Mitral stenosis caused by rheumatic heart disease (RHD) is the most common cause of valvular lesion in adults and prevalent in developing countries like Pakistan. Higher natriuretic peptide (BNP) levels can be observed in patients with moderate to severe untreated mitral stenosis and are associated with higher rates of morbidity and mortality. That is why this study aims to determine the association between levels of pro-BNP with severity (mild. Moderate, and severe) of mitral stenosis. Patients and Methods: This was a clinical prospective study carried out in the department of adult cardiology, national institute of cardiovascular diseases, Karachi from 8th august 2019 to 7th February 2020. Total 68 patients of either gender with age between 25-70 years had mitral stenosis of moderate to severe intensity (mitral valve area ≤1.5 cm2), diagnosed on echocardiography were included for final analysis. A simple blood sample was taken for the assessment of pro-BNP levels. Questionnaire was used for demographic & clinical data collection and analysed using SPSS version 22.0. Results: The overall mean age of study subjects was 42.21±11.50 years, ranging from 25 – 70 years. Among them, females were prevalent (n = 43, 63.2%). The overall mean serum BNP level was 1071.12±807.26 pg/ml and the mean difference of serum BNP level was not significant among groups of gender, age, and diabetes mellitus with p>0.05. Significantly raised levels of BNP were observed in patients with severe mitral stenosis as compared to moderate mitral stenosis, p<0.05 Conclusion: In conclusion, the mean BNP levels were higher in patients with severe Mitral Stenosis. Therefore, BNP may be used to complement the clinical and echocardiographic assessments in patients with Mitral Stenosis.