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Background Egypt is the most populous country in Middle East and North Africa and has one of the highest rates of the cardiovascular (CV) deaths in the region. Despite governmental primary preventive efforts, very little is known about the prevalence and characteristics of premature coronary artery disease (CAD) among Egyptian patients with Acute Coronary syndrome (ACS). Methods From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, spanning the Mediterranean coast, Nile Delta, and Upper Egypt, with focus on premature CAD (defined as ACS before age 55 years in males and 65 years in females). Results The prevalence of premature CAD was 51%. They were significantly more females (35% versus 16%, P<0.001) with significantly higher level of education. Risk factors' (RFs) distribution showed a significantly higher prevalence of Type-1 Diabetes Mellitus (6% versus 4%, P=0.005), obesity (42% versus 33%, P<0.001) and smoking (50% versus 47%, P<0.001) in patients with premature CAD when compared to others. Interestingly, rates of documented dyslipidemia were similar between groups (49% versus 47%, P=0.45) with no significant difference in low density lipoprotein-cholesterol levels (131.7±48.5 versus 130.2±45.2 mg/dl, P=0.4). Patients with premature CAD tended to present more frequently with ST-elevation myocardial infarction (STEMI) (50% versus 46%, P=0.035), with higher rates of treatment using primary percutaneous coronary intervention compared to others (48% versus 44%, P=0.04). They were also significantly less likely to receive Coronary Artery Bypass Graft (4% versus 6.5%, P=0.003). Conclusion Prevalence of premature CAD is high among Egyptian patients with ACS, due to noticeably larger burden of traditional CV RFs especially smoking and possibly familial hypercholesterolemia. Much effort is still needed in screening for early detection of RFs of atherosclerosis together with more widespread adoption of diagnostic scores for FH such as Dutch Lipid Network criteria. Acknowledgement/Funding AstraZeneca

High levels of pentraxin3 reflect severity of coronary lesions as measured by coronary angiography, very low levels of serum pentraxin 3 could exclude presence of risk for those patients completely so, it is considered agood negative test. We aimed to assess the diagnostic accuracy of C-reactive protein and pentraxin3 in acute coronary syndrome compared with cardiac troponin-1 Methods: A cohort study was conducted on 100 patients and were divided into:NSTE-ACS (NSTEMI and UA) included 70 patients. Non-ACS (SCAD and non-cardiac) included 30 patients. Laboratory investigations were done . Resting 12 leads surface Electrocardiogram (ECG) was done. Echocardiography to assess the left ventricular systolic function was done. By dividing our study populations into 4 groups NSTEMI, UA, SCAD and Non-ACS (non-cardiac),There was highly statistical significant difference regarding hs-CRP, CTnI and PX3. There was statistical significant difference regarding LVEF between group I & III, I & IV, II & III and II & IV. The best cut-off value considering the diagnostic accuracy of PX3 in prediction of acute coronary syndrome is 1.6 with 94.3% sensitivity and 60% specificity, for CTnI is 0.055 with 78.6% sensitivity and 53.3% specificity. Elevated levels of hs-CRP and serum PTX3 in the early hours clearly shows that they can be used as novel markers in the diagnosis of ACS. Their estimation in the early hours of ACS aid in the diagnosis and management of ACS.

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Aim: Our aim was to study the correlation between the thyroid hormones level and the coronary lesion complexity in patients with acute coronary syndrome (ACS). Patients and Methods: This is a prospective which included 100 patients with ACS who were admitted for percutaneous coronary intervention (PCI). The patients were divided according to thyroid functions into 3 groups: Euthyroid patients (90 patients), hyperthyroid patients (2 patients), and hypothyroid patients (8). Results: There was statistically significant correlation between 3 groups of thyroid hormone levels and BMI and myocardial infarction (MI). There was statistically non-significant differences between the 3 groups of thyroid functions(euthyroid, hyperthyroid and hypothyroidism) as regarded Age, Sex, Hypertension, DM, Coronary artery disease(CAD),Congestive heart failure (CHF), Blood diseases, PCI ,taking aspirin or warfarin, Ejection fraction, HbA1C, liver function tests, C-Reactive protein(CRP)level and Troponin marker. There was not a significant correlation between Syntax score and Age, International normalized ratio(INR), (Thyroid stimulating hormone)TSH level, Free Thyroxine (FT4), Ejection fraction and HbA1C.Syntax score was significantly inversely related to serum triiodothyronine (FT3) levels. In addition to its correlation with the syntax score, FT3 was shown to be a reliable predictor of CAD severity on its own. This suggests that FT3, rather than FT4 and TSH levels, may be utilized to predict the severity of CAD. Conclusion: FT3 levels below 2.65 nmol/L are a strong indicator of coronary artery lesion severity. A lower FT3 level is a continuous variable that may be utilized as a predictor of an increased risk for severe CAD.

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We aimed to evaluate feasibility, contrast utilization and complications of trans-radial approach comparing the left distal trans-radial artery (lt. dTRA) access versus conventional right trans-radial artery (rt. TRA) access in coronary angiography. Subjects and Methods: This study was conducted on (100) patients who underwent coronary angiography (50 patients via lt. dTRA & 50 patients via rt. TRA) and was performed in the department of cardiology, Benha University Hospital. All patients performed ECG, echocardiography, arterial doppler pre and post procedures.