Aim: To compare the incidence of in-hospital complications between diabetic normotensive and hypertensive diabetic patients presenting with acute myocardial infarction (MI) Methodology: This observational cohort study was conducted at National Institute of Cardiovascular Diseases Karachi from May 2019 to April 2020. We examined 220 diabetics with acute MI were included. 50% of the patients had high blood pressure and the rest had normal blood pressure. After enrollment in the study, selectees were observed for acute myocardial infarction complications in the hospital. Results: Most of the baseline characteristics were similar in both groups of patients. However, the hypertensive patients in the diabetes group had diabetes, high heart rate, and high blood pressure at reporting. The complication rates did not differ statistically between the two groups. The rates of complications occurred between diabetes and normotensive hypertension; Atrial fibrillation (AF) 15.5% vs 12.7% p = 0.194, respectively, ventricular tachycardia (LH) 14.5% vs 13.6%, AV block type-1 8.2% vs 7.3% p = 0.296, type2 AV block 2.7% vs 1.8% p = 0.352, complete heart block 11.8% vs 10% p = 0.313, acute congestive heart failure (CHF) 13.6% VS% 9.1 p = 0.137, left ventricular failure (LVF)19.1% vs 16.4% p = 0.259, cardiogenic shock (CS) 14.5% vs 10.9% p = 0.184, recurrent IM (Re-MI) 14.5% 10.9% p = 0.184 and mortality 14.5% vs 12.7 and% p = 0.326, respectively. Conclusion:It is concluded that diabetic patients with hypertensionhave not elevated risk of complications in the hospital after acute myocardial infarction. Key words: diabetes, hypertension, hospital complications, acute myocardial infarction
Objectives: The objective of this study was to determine the predictive value of GRACE score for predicting obstructive coronary artery disease in patients with non ST-segment elevation myocardial infarction (NSTEMI). Methodology: This cross-sectional study was conducted at the largest public sector cardiac care center of the Pakistan between January 2020 and June 2020. In this study, we included adult patients diagnosed with NSTEMI and correlation of GRACE score was assessed with angiographic finding of obstructive CAD defined as ≥50% stenosis in the left main or ≥70% stenosis in other coronary arteries. Results: A total of 227 patients were included in this study, out of whom 72.2% (164) were male patients and mean age was 55.77 ± 9.15 years. Mean GRACE score was found to be 95.89 ± 21.15. On coronary angiography obstructive CAD was present in 84.6% (192) of the patients. Area under the cure for predicting obstructive CAD was 0.669 [0.552 to 0.785]. The optimal cutoff value of GRACE score was ≥ 84 with sensitivity of 79.7% [73.3% to 85.1%] and specificity of 57.1% [39.3% to 73.7%]. GRACE score of ≥ 84 was found to be an independent predictor of obstructive CAD with odds ratio of 4.33 [1.61 - 11.64; p=0.004] adjusted for gender, age, hypertension, diabetes, family history of CAD, and smoking. Conclusion: GRACE score has a moderate predictive value in predicting obstructive CAD in patients with NSTEMI. The optimal cutoff value of 84 is an independent predictor with good sensitivity but moderate specificity in predicting obstructive CAD.
Objectives: Despite widespread use of smokeless tobacco (ST) in Pakistan, a very limited empirical evidence have been reported regarding its impact on the coronary anatomy and obstructions. Therefore, this study was conducted to compare the coronary angiographic profile of smokeless tobacco (ST) users and smokers with non-tobacco users presented with acute myocardial infarction (AMI). Methodology: Consecutive patients with AMI were stratified in to four groups as tobacco non-users (G1), solo ST users (G2), both smoking and ST users (G3), and solo smokers (G4). Coronary angiographic findings regarding number of diseases vessels and infarct related artery were recorded. Results: Out of 326 patients, ST users were 28.2%(92), 6.4%(21) in conjunction with smoking and reaming 21.8%(71) without smoking. Females were 19.7%(14/71) of G2, 4.8%(1/21) of G3, 0% in G4. Young patients (≤ 40 years) were 3.4%(5/149) of G1, 9.9%(7/71) of G2, 14.1%(12/85) of G4, and 23.8%(5/21) of G3 cumulatively making 82.8%(24/29) of the young patients. Single vessel disease (SVD) and left anterior descending artery (LAD) were significantly higher among ST user as compared to non-users with distribution of 46.7% vs. 34.2% and 70.7% vs. 56.4% respectively. Conclusion: The distribution and localization of involved vessels among ST users with AMI are same as that of smokers with SCD and LAD as infarct artery as the common findings. Tendency of ST use is also high among female patients and Tobacco use in either form, smoking or smokeless, is alarmingly high (>80%) among young (≤40 years) patients with AMI.
Objectives: The main objective of the study was to evaluate the knowledge of patients for stents and post PCI pharmacotherapy. Methodology: A cross-sectional study was carried out on 102 consecutive selected patients with age ≥ 18 years who had undergone elective PCI. Various patient characteristics including demographics, previous history of cardiac problems, evaluation processes and overall knowledge were assessed using the survey questionnaire. With regards to evaluating levels of knowledge and awareness, the percentage for the number of correct answers about the dangers and advantages of elective PCI, clinical therapy for CAD, and bypass surgery was calculated. Results: A total of 102 patients were include, 78(76.5%) were male with mean age of study population was 53.93±11.0 years and majority 66(64.7%) were above 50 years of age. On analysis of demographics data it was observed that 74(72.5%) were educated. The results showed that adequate knowledge (≥70%) was observed only in 16.7% while there was not a single patient who answered all the questions in the correct fashion. Conclusion: Patients undergoing PCI had inadequate knowledge about the stents and post PCI pharmacotherapy.
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