Objective: This research aimed to characterize the clinical presentation, frequency, and distribution of CAAs in people experiencing angiography. In this study, we reviewed the presence of CAAs in 4072 patients. Study design: Cross-section study Study Setting: Current research was conducted at Department of interventional cardiology, MTI- Hayat Abad Medical Complex, Peshawar from Ist July 2021 to 30th June 2022. Methods: The current research analyzed data from 4072 angiograms performed. The medical record of the patients was used to recruit the CAAs patient’s profile. Angelini's categorization was used to categorise the coronary anomalies and two interventional cardiologists reviewed each coronary angiography separately, and in the event of a discrepancy, a senior cardiologist was contacted to achieve a consensus. GE 520 and GE 2100 were used for the coronary angiogram. Operators have the option of using either a radial or femoral incision. Results: Finding of the CAAs was found in 103 cases of CAAs (a prevalence of 2.5%). According to the data, the average age of the patients was 59.64±13.73. Of them, 89 (2.19%) individuals had anomalous coronary origin and/or course, 9 (0.2%) had intrinsic coronary arterial system abnormalities, 3 (0.07%) had anomalous coronary termination, and 2 (0.04%) had a single coronary artery. Overall, 36 individuals (0.44%) were found to have an aberrant right coronary artery (RCA), with the RCA emerging from the left coronary sinus; this was followed by 54 patients (1.3%) who lacked a left main trunk and instead had a distinct origin for the LAD and LCX. Practical implication: Our understanding of CAAs has considerably improved from the development of novel diagnostic techniques, although the majority of the data available today comes from case reports and small case series. Further research is needed to fill the knowledge gap regarding the clinical effects of CAAs and their prognosis because epidemiological data are taken from studies conducted in other countries. Conclusion: Overall, 2.5 percent of research participants had congenital coronary abnormalities. The highest prevalence was found in anomalies origin and course. This study's prevalence of CAAs was comparable to that of other research, although the distribution of abnormalities was a little bit different. Keywords: Congenital Coronary Artery Anomalies, Coronary Angiography, Prevalence, Pattern
Background and aim: The most common approach of percutaneous myocardial revascularization is stent placement. In de novo focal lesions found in big native arteries, balloon angioplasty had lower efficacy than coronary stenting. However, the usefulness of stenting in small arteries remains debatable. The purpose study aimed to compare the efficacy of coronary stenting vs. balloon angioplasty in small coronary arteries. Patients and Method: This comparative study was carried out on 132 patients with lesion in small coronary arteries (reference diameter <3mm) in the department of Interventional Cardiology, MTI- Hayat Abad Medical Complex, Peshawar from 16th January 2021 to 15th July 2022. Patients were arbitrarily assigned to stent implantation and standard balloon angioplasty. Study protocol was approved by research and ethical committee. Each individual provided written informed consent. The rates of clinical event were evaluated within 1 year. Descriptive statistics was carried out in SPSS version 26. Results: Of the total patients, there were 80 (60.6%) male and 52 (39.4%) were females. Both groups were assigned 66 patients and had similar baseline characteristics and angiography data. Based on treatment analysis, the major adverse cardiac events (MACEs) and angiographic success rate were similar: 5.2% and 96.8% in coronary stenting versus 5.9% and 92.4% in balloon angioplasty group respectively. About 4.2% patients underwent abrupt closure changes within 30 days. Stenting convened the substantially larger lumen (1.52 mm vs. 1.32 mm, p<0.001) at 6 months and larger post-procedural lumen diameter (2.31 vs. 1.82 mm, p<0.001) as compared to balloon angioplasty. The incidence of restenosis was found 36% and 56% in coronary stenting and balloon angioplasty respectively. The survival rate (event-free) was achieved in 79% and 69% (p=0.021) in coronary stenting and angioplasty respectively. Conclusion: The present study found that optimum balloon angioplasty with preliminary stenting may be a viable therapeutic option for small coronary arteries lesions. Restenosis was found to be 36% and 56% in coronary stenting and balloon angioplasty, respectively. Keywords: Restenosis, Small coronary arteries, Balloon angioplasty, Coronary stenting
Background and aim: Suboptimal coronary blood flow following first percutaneous coronary intervention (PCI) is a multivariate phenomenon with several causes. Despite substantial research, recognized modifiable risk factors and an effective management plan are lacking. The present study intended to determine the several causes of suboptimal coronary blood flow during primary percutaneous intervention. Patients and Method: A retrospective study was carried out on 486 STEMI patients in the Interventional Cardiology Department, MTI-Hayatabad Medical Complex, Peshawar from June 2021 to May 2022. Patients (age>20 years) presented with initial percutaneous coronary intervention within 12 hours after onset of symptoms were enrolled. Patients’ physical examination, medical history, different risk factors, vital signs assessment, echocardiography, Killip class, laboratory investigation, and post-procedural ECG were recorded along with PCI data and associated catheterization. Clinical outcomes included MACE, ischemia-driven target vessel revascularization, reinfection, cardiac mortality, and post-catheterization were recorded. Descriptive statistics was done in SPSS version 26. Results: Of the total 486 STEMI patients, there were 412 (84.8%) male and 74 (15.2%) females. The overall mean age was 52.62± 8.64 years. The incidence of suboptimal flow (TIMI flow ≤2) and optimal flow (TIMI-3 flow) were 112 (23%) and 374 (77%) respectively. Age [OR 1.041/year: p<0.001], total stent length [OR 1.019 per 1 mm], low SBP [OR 1.021 per mm Hg], thrombus burden grade [OR 1.78], and baseline TIMI flow (≤1) [OR 1.72; p=0.021] were suboptimal flow independent predictors. Cardiac mortality and MACE were significantly higher after 30-days in suboptimal flow as compared to optimal flow. The prevalence of in-hospital mortality in suboptimal flow and optimal flow was 9.1% and 2.1% respectively. Conclusion: The present study found that suboptimal coronary flow after first PCI is substantially associated with higher in-hospital and cardiovascular mortality in STEMI. The most significant predictor of poor coronary flow is predilatation prior to stenting. Keywords: Suboptimal coronary flow, Primary percutaneous intervention, Predictors
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