Background: COVID-19 can cause a wide range of thrombotic diseases, including acute coronary syndromes (ACS). While these thrombotic diseases occur during acute infection, evidence on the long-term thrombotic consequences of COVID-19 remain unknown. Objective: The aim of the current study was to establish the particular coronary angiographic findings, as well as the procedural and clinical effectiveness of revascularization in post COVID-19 patients presenting with STEMI. Patients and methods: A total 100 patients presented to Ain Shams University Hospitals with ST Segment Elevation Myocardial Infarction (STEMI) managed by primary percutaneous coronary intervention (PCI). Participants were divided into two groups: Group (A) included 50 patients who developed COVID-19 infection in the previous 6 months, and Group (B) included 50 patients who deny COVID-19 infection in the previous 6 months. Group (A) was divided into two subgroups: the Early Post-COVID subgroup, which included 16 patients who developed STEMI within 8 weeks of infection, and the Late Post-COVID subgroup, which included 34 patients who developed STEMI >8-24 weeks after infection. Results: The Early Post-COVID subgroup had a statistically significant high thrombus load on angiography, with 81.3% versus 48% in the control group. This resulted in a statistically significant increase in the utilization of predilatation (56.2% versus 24%) and thrombus aspiration (43.8% versus 4%) in the Early Post-COVID grouping (Pvalues 0.015 and 0.001, respectively). Coronary no-reflow was a substantially more common in the Early post-COVID subgroup (62.5%) than in the control group (22%). This translated into a higher Major Adverse Cardiovascular Events (MACE) among Early Post-COVID patients, at 31.3% versus 6% in the control group. Conclusion:The thrombogenic impact of COVID-19 on STEMI outcomes continues even after infection clearance being greatest during the first 8 weeks following infection and thereafter diminishes. It has an impact on the angiographic, procedural, and overall clinical success of in-hospital revascularization.
Background: Regional ST-segment–elevation myocardial infarction (STEMI) networks facilitate timely performance of primary percutaneous coronary intervention (PPCI), reduce mortality and improve outcomes. Few data exist on the feasibility and impact of regional STEMI networks in developing countries. Aim of the Work: The aim of this study was to examine the feasibility and impact of establishing a regional STEMI network on the management and outcomes of STEMI patients in north Cairo. Patients and Methods: A prospective observational study conducted on 352 patients presenting in North Cairo with confirmed diagnosis of STEMI within 48 hours of symptoms. Patients were divided into group I (n = 140) before and group II (n = 212) after establishment of the STEMI network. Both groups were compared as regards patients’ demographics, presentation, management and short-term outcomes. The north Cairo regional STEMI network was established among four governmental hospitals and the governmental ambulance was used for interhospital transfer. WhatsApp® was used for trans-network team communication. Results: Mean age of the study population was 55.4 ± 11.02 years and 286 (81.3%) were males. Mean time from chest pain to first medical contact did not change between the two groups (240 minutes; P = 0.36) while door to balloon mean time was reduced (from 54.3 to 44.1 minutes: P = 0.01). Use of thrombolytic therapy declined from 51 (36.4%) to 16 (7.5%) (P < 0.001) while primary PCI increased from 59.8% to 77.1% (p < 0.001). Left ventricular ejection fraction improved from 51.3 ± 10.7 to 55.4 ± 9.1 (P < 0.001), the mean time of CCU stay was reduced from a mean of 3.0 to 2.0 days (P < 0.001) and in-hospital mortality improved from 6.4% to 2.8% (P = 0.10). Conclusion: The establishment of the STEMI network in north Cairo was feasible and improved patients’ outcomes. Use of primary PCI increased and in-hospital mortality improved from after establishment of STEMI network.
Background: Atherosclerosis is a systemic disease that causes luminal narrowing. Patients with peripheral arterial disease (PAD) also exhibit an increased risk of death from cardiovascular complications. This risk is the same for symptomatic or asymptomatic patients. Over a 5-year period, patients with PAD have a 20% chance of suffering from a stroke or myocardial infarction. Additionally, their mortality rate is 30%. This study aimed to assess the relationship between coronary artery disease (CAD) complexity using SYNTAX score and PAD complexity using Trans-Atlantic Inter-Society Consensus II (TASC II) score. Methods:The study was designed as single-center cross-sectional observational and included 50 diabetic patients referred for elective coronary angiography and peripheral angiography was done.Results: Most of the patients were males (80%) and smokers (80%) with mean age of 62 years. The mean SYNTAX score was 19.88. There was a significant negative correlation between SYN-TAX score and ankle brachial index (ABI) (r = -0.48, P = 0.001) and a significant positive correlation with glycated hemoglobin (HbA1c) level (R 2 = 26, P = 0.004). Complex PAD was found in nearly half of the patients with 48% having TASC II C or D classes. Those with TASC II classes C and D had higher SYNTAX scores (P = 0.046).Conclusions: Diabetic patients with more complex CAD had more complex PAD. In diabetic patients with CAD, those with worse glycemic control had higher SYNTAX scores and the higher the SYNTAX score, the lower the ABI.
Background: One of the main health issues in the world is coronary artery disease (CAD). It frequently causes morbidity and death. From 28.9% in the 1990s to a predicted 36.3% in the 2020s, the global death rate for CAD is anticipated to increase. Objective: The aim of the current study was to confirm the relationship between the epicardial adipose tissue thickness on echocardiography and CAD severity. Patients and Methods: Epicardial adipose tissue thickness (EATT) was measured by echo in 200 patients referred for coronary angio in Ain Shams University between May 2013and October 2014. Results: In our study, diabetic, hypertensive and smoker patients had more significant EATT when compared to non-diabetic, non-hypertensive and non-smoker ones. EATT measured during both systole and diastole was found to be significant in patients with BMI ≥30 and abnormal waist hip ratio when compared to corresponding values of normal BMI and waist hip ratio. On measuring EATT during both systole and diastole, it was found that P-value was significant in high levels of LDL and TGs patients compared to corresponding values in normal levels of LDL and TGs subjects. EATT was highly significant in patients with coronary affection with mean EATT(s) in CAD patients was 6.07 (SD 1.16) compared to 4.22 (SD 0.9) in patients with normal coronaries and mean EATT(d) in CAD patients was 5.77 (SD 1.13) compared to 4.02 (SD 0.9) in patients with normal coronaries. Also, there was a significant correlation between measurements of both systolic and diastolic EATT and the number of diseased coronary artery in CAD patients. Our study showed no significant correlation between gender and EATT measurements during both systole and diastole. Conclusion: A significant correlation exists between EAT and the existence and severity of CAD. It supports the idea that epicardial fat may contribute to the development of CAD, presumably through paracrine or vasocrine pathways. EAT may be evaluated safely and non-invasively by echocardiography, as it may be a component of the normal evaluation of individuals suspected of being at risk for cardiovascular or metabolic disorders.
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