Objective: To determine the frequency of Right Ventricle infarction and in-hospital outcome after primary percutaneous coronary intervention in patients with acute inferior MI. Study Design: Descriptive Cross Sectional Study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, from Dec 2018 to Jun, 2019. Methodology: Non-probability consecutive sampling technique was used. Permission was sought from hospital ethical committee and informed consent was taken from participants of the study. Patients presenting with acute inferior MI who underwent Primary Percutaneous Coronary Intervention were assessed for presence of Right Ventricle infarct. All the patients’ data and variables of the study was recorded in the data collection sheet. Patients underwent venous blood sampling for Complete blood count, Renal function tests, Liver function tests, Blood glucose random, Troponin-I, cardiac enzymes and Coagulation profile at presentation in emergency department. Results: Total 261 patients were included according to the inclusion criteria of the study. Mean age (years) in the study was 58.0 ± 12.59 whereas there were 183 (70.1) male and 78 (29.9) female patients who were included in the study. Frequency of right ventricular infarction and in-hospital outcome (mortality) after Primary Percutaneous Coronary Intervention in patients with acute inferior MI was assessed in the study which was 73 (28.0) and 20 (7.7) respectively. Conclusion: The study concluded that frequency of in-hospital mortality is substantial due to major adverse cardiac events in patients with right ventricle infarction.
Objective: To study the short-term and long-term outcomes of left main angioplasty at AFIC-NIHD. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD) in 2018. Methodology: All cases of left main angioplasty done in 2018 were included in the study. The patients were followed up in clinic or on telephone and mortality (in-hospital, 30 days) outcomes and survival duration were recorded. Kaplan Meier curves were generated to show the survival difference between those who underwent primary or elective LMPCI and survival difference between patients based on extent of coronary artery disease. Results: A total of 73 patients underwent elective or primary left main angioplasty. The extent of coronary artery disease was: single vessel coronary artery disease (26%), double vessel coronary artery disease (37%), and three vessel coronary artery disease (37%). Thirteen patients (17.8%) had primary left main angioplasty, and 60 patients (82.2%) had elective left main angioplasty. Intravascular ultrasound was performed in only 3 patients. The mean duration of follow up was 395 days. A total of 6 (8.2%) patients died. Three patients died in-hospital, another 2 within the first 30 days, and the remaining beyond 30 days. Two of the dead patients had double vessel coronary artery disease, and 4 had three vessel coronary artery disease. The survival difference between the primary vs elective groups was insignificant (Log Rank (Mantel-Cox) (p=0.27). The survival difference between the 3 groups with different extent of coronary artery disease was insignificant (p=0.15). Conclusion: Left main PCI is a safe procedure with acceptable outcomes. Patients with more severe coronary artery disease tend to fare worse.
Objective: To assess long term outcomes of CT Angiography in low to intermediate risk patients of suspected ACS and to assess if CT-angiography is a safe modality to discharge patients with clinically non-significant coronary artery disease. Study Design: Descriptive cross-sectional study Place and Duration of Study: Tertiary Cardiac Center in Rawalpindi, from Dec 2021 to Apr, 2022. Methodology: A total of (n=600) patients who presented with ischemic sounding chest pain and suspicion of acute coronary syndrome (ACS) were selected via consecutive sampling technique and were followed up to 5-months. Patients' demographics, CT-Angiography findings and their outcomes were noted on data collection sheet. Data was analyzed by SPSS version-23. Descriptive statistics were run to present categorical data in frequencies and percentages. Chi-square and Fisher Exact Test was applied to find the association between study variables at 95% CI and 5% margin of error (α=5%). Results: Out of (n=600) suspected cases of acute coronary syndrome (ACS), n=352 (58.7%) were males and n=248 (42.3%) were females. As a result of follow-up of the ptaients, cases that represented in emergency department, readmission cases and revascularized cases were (n=10,4, 1;1.7%, 0.7%, & 0.2%) respectively. Frequency of ACS and STEMI patient was 0.0%. Mortality rate was 0.0%. There was significant association of comorbids with CT-angiography findings and the findings with outcome variables (p<0.05) except revascularization (p>0.05). Conclusion: In low to intermediate risk patients of suspected ACS, discharge decision from emergency department based on CT-angiography findings is safe and shows excellent long-term outcomes with no major adverse cardiac event (MACE) on long-term follow-up.
Objective: To assess the maternal and fetal outcome in pregnant patients with preexisting cardiac conditions and to determine the prevalence of different cardiac diseases among pregnant patients. Study Design: This was across sectional study. Place and Duration of Study: Tertiary Cardiac Care Center in Rawalpindi Pakistan, from Dec 2021 to Apr 2022. Methodology: This was across sectional study done in a tertiary cardiac care center in Rawalpindi. A total of (n=100) pregnant patients with pre-existing cardiac diseases were included in the study from Dec 2021 to Apr 2022 over a period of 5 months. Prospective data including patients' demographics and their outcomes was collected using preformed proformas. Data was analyzed by SPSS version-23. Prevalence of maternal death, fetal death, maternal complications and neonatal complications were the primary outcomes of study. Descriptive statistics were run to present categorical data in frequencies and percentages. Chi-square and Fisher Exact Test was applied to find the association between study variables at 95% CI and 5% margin of error (α=5%). Results: A total of (n=100) patients were included in our study which was conducted from Dec 2021 to Apr 2022. Maternal mortality was observed in 6% (n=6) of patients. Maternal outcomes of pulmonary edema were seen in 24% (n=24) of patients and post-partum hemorrhage was seen in 14% (n=14) patients. Three parameters of perinatal outcome were studied i.e., low birth weight, preterm delivery and death. 39% (n=39) neonates were found to have low birth weight, 22% (n=22) were preterm and perinatal mortality was 21% (n=21). The primary results of our study showed 6% (n=6) maternal mortality and 21% (n=21) perinatal mortality. Conclusion: Overall maternal mortality was 6% while perinatal mortality was 21%. There existed a statistically significant (p<0.05) association of age and neonatal outcome with maternal complications. With proper counseling, some of the avoidable maternal and perinatal deaths can be prevented.
Objective: To assess whether status of allergies is accurately documented in clinical notes and drug prescription charts in two medical wards in Armed Forces Institute of Cardiology (AFIC) as compared to NICE guidelines. Study Design: We designed a classic audit of measuring current practice against guidelines.Place and duration of Study: Armed Force Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD), Rawalpindi Pakistan, from May to Oct 2020.Methodology: Each cycle contained of a two weeks’ period in which all new patients admitted in coronary care ward 3 and ward 10 were assessed. A total of 110 patients were assessed in each cycle. Repeat audit cycle was performed after 6 months similarly.Results: In first audit cycle, we assessed 110 patients. The status of allergies for most patients was recorded in clerking proforma (n=103, 93%) but there were deficiencies found in recording of allergies on drug kardex (n=25, 22%). After education and awareness, the second cycle showed that the status of allergies for all patients was recorded in clerking proforma (n=110, 100%) and documentation on drug kardex also improved from 22% to 78%. Conclusion: Repeat audit cycle showed significant improvement in documentation of allergies in clerking proforma and on drug kardex.
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