AimsWe aimed to compare the GRACE and TIMI risk scores in patients with non- ST elevation acute coronary syndrome for their accuracy in predicting the angiographic severity of coronary artery disease.MethodThe cross-sectional study done in the Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from April, 2015–April, 2016. The patients admitted with non-ST elevation acute coronary syndrome were evaluated to calculate the GRACE and TIMI risk score. Coronary angiogram was done during index hospitalization and the severity of coronary artery disease was assessed by vessel score and Gensini score.ResultsOf 205 patients, a positive correlation of the vessel score and Gensini score was observed with both the GRACE and TIMI risk scores (p = <0.001) and the GRACE score (r = 0.55) correlated better than the TIMI score (r = 0.51). The GRACE score presented area under the Receiver Operating Characteristic (ROC) curve (0.943; 95% CI = 0.893–0.993) significantly superior to the area under the ROC curve (0.892; 95% CI = 0.853–0.937) of the TIMI score.ConclusionBoth the GRACE and TIMI risk scores had good predictive value in assessment the severity of coronary artery disease in patients with non-ST elevation acute coronary syndrome, when they were compared, the GRACE score was found to be superior to the TIMI score.

Background and Objective: Trans-radial approach of coronary catheterization has been increasingly used as an alternative to transfemoral approach due to less vascular complications, earlier ambulation and improved patient comfort. The aim of the study was to compare procedural and post procedural vascular complications in patients with percutaneous coronary intervention by trans-radial and transfemoral approach. Methods: This observational comparative study was conducted in the National Institute of Cardiovascular Diseases between June 2015 to May 2016. A total of 180 patients were categorized into two groups according to the approach of the percutaneous coronary intervention (PCI). Group I comprising 90 patients who underwent trans-radial PCI and group II consists of 90 patients who underwent transfemoral PCI. Patients with an abnormal Allen’s test, acute coronary syndrome, history of coronary artery bypass surgery, chronic renal insufficiency or older age (>75 years) were excluded. Results: Patient demographics were the same in both groups. The mean procedural time in min (37.44±5.13 vs 34.14±4.42, p=0.004) and fluoroscopy time in min (21.62±4.11 vs 17.55±2.78, p=0.02) were more in TR-PCI group but the mean haemostasis time in min (7.58±1.11 vs 15.59±3.33, p=0.005) and ambulation time in hour (0.00±0.00 vs 15.59±3.33, p=<0.001) were more in TF-PCI group. Significant arterial spasm following puncture (6.7% vs 0%, p=0.01) were found in trans-radial group but access site bleeding during procedure (2.2% vs 8.9%, p=0.04) were more in TF-PCI group. After the procedure major hematoma (0% vs 4.4%, p=0.04), minor hematoma (5.7% vs 14.4%, p=0.04) and ecchymosis (4.4% vs 13.3%) were significant in TF-PCI group but vessel occlusion (5.7% vs 0%, p=0.02) were significant in TR-PCI group. The mean hospital stays, day (1.64±0.42 vs 2.54±0.62) were more in TF-PCI group. Conclusion: TR-PCI is safe in respect of procedural and post procedural vascular complications. Trans-radial procedure leads to improved quality of life after the procedure and thus gives much comfort to the patient. It also shortened mean duration of hospital stay. So, trans-radial approach is an attractive alternative to conventional transfemoral approach. Bangladesh Heart Journal 2019; 34(2) : 86-91

Introduction:Cardiovascular diseases account for more than 17 million deaths globally each year. This figure is expected to grow to 23.6 million by the year 2030. Coronary artery disease alone caused 7 million deaths worldwide in 2010 and it is an increase of 35% since 1990. 1 The incidence of non-ST elevation acute coronary syndrome to ST elevation myocardial infarction is increasing, probably as a result of demographic changes in the population, including progressively increasing numbers of older persons and higher rates of diabetes mellitus. 2 NSTEMI currently accounts for about 50% of all myocardial infarctions. With the increased use of beta blockers and aspirin the incidence of NSTEMI is increasing. 3 The 6-month mortality rate in the patients with NSTEMI is about 6.2% and re-hospitalization rates over the 6 month is about 20%. This type of prognosis in patients with NSTEMI can be assessed by early risk stratification. Several risk scores are developed in predicting the outcomes in patients with acute coronary syndrome including NSTEMI. The most popular risk scores are the GRACE and TIMI risk scores. These risk scores calculate the patient's risk of mortality which depends on the severity of coronary artery disease and other comorbid conditions. But estimating the possible severity of coronary artery disease by these scores before performing coronary angiography may change the therapeutic decision and the timing or intensity of interventions.

Background: Obesity, measured on the basis of body mass index (BMI), is an independent cardiovascular risk factor. However, some studies have reported the “obesity paradox” after percutaneous coronary intervention (PCI). The relationship between BMI and clinical outcomes after PCI has not been thoroughly investigated, especially in Bangladesh.Method: This cross sectional observational study was conducted at National Institute of Cardiovascular Diseases, on total 100 patients who underwent PCI with two equally divided groups on the basis of BMI of Asian ethnicity: Group I (BMI < 23 kg/m2) and Group II (BMI e” 23.0 kg/m2). In-hospital outcomes were observed and recorded after PCI.Results: The mean BMI of study population was 23.9 ± 1.9 kg/m2. The sum of occurrence of adverse in-hospital outcomes was 14.0%. Complications were significantly (p < 0.01) higher in Group I than Group II. Among all adverse in-hospital outcomes, only acute left ventricular failure was found to be statistically significant between groups (p < 0.01). The difference of mean duration of hospital stay after PCI was higher in Group-I which was statistically significant (p < 0.01). Diabetes mellitus and dyslipidemia were found to be the independent predictors for developing adverse in-hospital outcome (OR= 1.68 and 1.46; 95% CI = 1.25 – 2.24 and 1.16 – 1.83; p = 0.018 and 0.040, respectively). BMI was inversely associated with adverse in-hospital outcome after PCI (OR = 0.95; 95% CI = 0.91 – 0.98; p = 0.007).Conclusion: BMI is inversely associated with adverse in-hospital outcomes after PCI. The underweight and normal weight people are at greater risk to experience in-hospital adverse outcomes than overweight and obese people following PCI.Cardiovasc. j. 2017; 10(1): 31-39

Background: The Ankle-Brachial Index has been shown to be a good marker of systemic atherosclerosis and a powerful indicator of cardiovascular morbidity and mortality This study evaluated the relation of ABI with the angiographic severity of patient with coronary artery disease.Methods: This is a hospital based cross-sectional analytical study. 100 adult Bangladeshi patients who were admitted and underwent coronary angiography according to inclusion and exclusion criteria were the study population. All patient’s ABI were measured and coronary angiography were done. Patients were divided into two groups according to ABI. Group I with ABI >0.90 and group II with ABI <0.90.Results: In group I 65(82.2%) were men and 16(19.8%) were women. In group II 18(94.7%) patients were men and 1(5.3%) was women. Significant co-relation was found between low ABI and severity of CAD. Low ABI group showed more severe form of CAD with higher prevalence of triple vessel diseases, significant stenosis and more involvement of left main (LM) and left anterior descending(LAD)artery. Single vessel disease was found more with normal ABI. Hypertension, diabetes mellitus and Low ABI showed predictors of significant severe stenosis of coronary arteries.Conclusion: Low ankle brachial index is a predictor of the severity of coronary artery disease. So it could be incorporated in our day to day clinical cardiology practice as non-invasive, bedside test to assess and predict the severity of coronary artery disease.Cardiovasc. j. 2018; 10(2): 201-205

Background: Coronary dominance affects on in-hospital outcomes of patients with acute coronary syndrome and also affects the outcome following percutaneous coronary intervention. Left dominant anatomy is believed to be associated with worse prognoses for patients with acute coronary syndrome undergoing percutaneous coronary. This study evaluated the manner in which coronary dominance affects in-hospital adverse outcomes of acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI).Methods: Data were analyzed from 149 ACS patients who underwent PCI between November 2014 and October 2015 at National Institute of Cardiovascular Diseases (NICVD), Dhaka. The patients were grouped based on diagnostic coronary angiograms performed prior to PCI; those with right dominant plus co-dominant anatomy (RD+Co group) and those with left dominant anatomy (LD group).Results: Total adverse in-hospital outcome is 8.7% patients. In LD group 23.1% patients were experienced adverse in-hospital outcome, on the contrary 5.7% of the patients with RD+Co group did have such experience. About 2.7% patients developed arrhythmia, 2.7% cardiogenic shock, 2% acute left ventricular failure and 0.7% ischaemic chest pain of the both groups. Among them arrhythmia, acute left ventricular failure and cardiogenic shock were more common in LD group than RD+Co (7.7% vs. 1.6%, 7.7% vs. 0.8% and 7.7% vs. 1.6%) group. Multivariate logistic regression analysis revealed that smoking, diabetes mellitus and left coronary dominance were the independent predictors for developing adverse in-hospital outcome with ORs being 1.317, 1.074 and 6.553 respectively (p <0.05).Conclusion: Patients of left coronary dominant had higher in-hospital adverse outcome compared with patients of right dominant plus co-dominant in a population with acute coronary syndrome who underwent percutaneous coronary intervention and left dominant anatomy was an independent predictor for developing adverse in-hospital outcome.Cardiovasc. j. 2017; 9(2): 129-134

Hypokalemic periodic paralysis (HPP) is a rare autosomal dominant channelopathy characterized by skeletal muscle weakness or paralysis when there is a fall in potassium levels in blood. Weakness may be mild and limited to certain muscle groups or more severe causing generalized paralysis. During an attack, reflexes may be diminished or absent. Attacks may last for a few hours or persist for several days, ultimately resulting in complete recovery. Some patients may develop chronic muscle weakness later in life. Recurrent muscle weakness accompanied by hypokalemia and exclusion of other causes help establish the diagnosis. Potassium supplementation is the mainstay of treatment of acute illness. Lifestyle modification with or without pharmacotherapy in the form of carbonic anhydrase inhibitors and/ or spironolactone can prevent future attacks. Here, we present two cases of HPP, the first one had no positive family history and responded to oral potassium and spironolactone, while the second case had family history suggestive of HPP and was managed with potassium and eplerenone.

Introduction:Acute coronary syndrome (ACS) is a unifying term representing a common end result, acute myocardial ischemia. It encompasses acute myocardial infarction (MI) resulting in ST segment elevation MI (STEMI) or non STsegment elevation MI (NSTEMI) and unstable angina. 1 Currently, there are three main reperfusion strategies for STEMI: fibrinolytic therapy, primary percutaneous coronary intervention (PCI), and fibrinolytic-facilitated primary PCI. Approximately 95% of patients who are treated with primary PCI obtain complete reperfusion versus 50% to 60% of patients who are treated with fibrinolytics. 2 Several model of risk scores are developed for predicting short and mid-term outcomes in patients with ACS and to distinguish the patients at the highest risk or an adverse outcome who may benefit from aggressive therapies. The PURSUIT, TIMI, GRACE and FRISC risk score models are well validated in this regard. 3 Recently, the HEARTrisk score was developed. The Primary Angioplasty in Myocardial Infarction (PAMI) risk score is used to predict the six-month mortality. The Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) risk score is used to predict the one-year mortality. 4 The development of both risk scores (PAMI and CADILLAC) was based on individuals treated by invasive procedures. The dynamic TIMI risk model is an upgrade of the classic TIMI risk score, using in-hospital events for an easy reassessment of the risk of Patients discharged from hospital. 4 The Thrombolysis In Myocardial Infarction (TIMI) risk score was developed as a bedside tool to stratify STEMI patients eligible for reperfusion by their mortality risk.