No abstract

Background: Smoking is a well-established cardiac risk factor there is dearth of Local data regarding clinical and angiographic characteristics of smoker patients. Objectives: This study was planned to assess the differences in the clinical characteristics, angiographic characteristics, and in-hospital outcomes of smokers and nonsmokers after primary percutaneous coronary intervention at a tertiary care hospital in Karachi, Pakistan. Methods: We included patients between 40 and 80 years of age diagnosed with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention from July 1, 2017, to March 31, 2018. Clinical and angiographic characteristics and in-hospital outcomes were obtained from the cases submitted to the National Cardiovascular Data Registry's CathPCI (CatheterizationePercutaneous Coronary Intervention) Registry from our site. Results: A total of 3,255 patients were included in this study. Smokers consist of 25.1% (817) of the total sample. A high majority of smokers were male, 98.8% (807), and smokers were relatively younger as compared to nonsmokers with a mean age of 52.89 AE 10.59 versus 55.98 AE 11.24 years; p < 0.001. Smokers had higher post-procedure TIMI (Thrombolysis In Myocardial Infarction) flow grade III: 97.8% (794) versus 95.53% (2,329); p ¼ 0.037, and they had a relatively low mortality rate: 2.69% (22) versus 3.16% (77); p ¼ 0.502. Conclusions: Smokers were predominantly male and around 3 years younger than nonsmokers. Diabetes mellitus and hypertension were less common among smokers and single-vessel disease was the more common angiographic finding for smokers as compared to 3-vessel disease for nonsmokers. No statistically significant differences in in-hospital outcomes were observed. ST-segment elevation myocardial infarction in smokers despite younger age and the low atherosclerotic risk profile, in our region, emphasize the need for nicotine addiction management and smoking cessation campaigns at large and for pre-discharge counseling.

Objectives: A conflict of evidence exists regarding the gender-based differences in outcomes after primary percutaneous coronary intervention (PCI), therefore, aim of this study was to compare the clinical characteristics, angiographic findings, and outcome of primary PCI for men and women. Methodology: Data for this study was extracted from a prospectively managed primary PCI database of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. We included consecutive patients of either gender with STEMI undergone primary PCI. Data on clinical characteristics, angiographic finding, and post procedure outcomes for female were compared with male group and also with a propensity matched male cohort. Results: A total of 2400 patients were included with 421(17.5%) women. The mean age for the men and women were 54.44±11.16 and 57.17±11.01 years respectively; p<0.001. Women had significantly high prevalence of hypertension (61.0% vs. 39.1%; p<0.001), diabetes (37.1% vs. 23.9%; p<0.001), and obesity (18.5% vs. 13.5%; p=0.008). The median symptom onset to hospital arrival time was 216 [366-124] minutes vs. 180 [310-112] minutes; p=0.001 for women and men. In-hospital mortality rate was 3.8% vs. 2.5%; p=0.147 for female and unmatched male cohort, while it was 3.6% vs. 3.8%; p=0.855 for female and propensity matched male cohort. Conclusion: Gender-based differences persist in clinical profile of the patients with STEMI. Women are likely to be older in age with more diabetes, hypertension, and obesity. Gender-based difference in outcome of primary PCI is appears to be driven by differences in clinical profile as adjusted outcome is not different for men and women.

A left ventricular pseudoaneurysm is formed when there is free wall rupture of the myocardial wall with discontinuity and roof covered by pericardium mural thrombus or fibrous tissue without any myocardium. A left ventricular pseudoaneurysm is a rare and life-threatening event. We report a young 22-year-old female with unknown etiology of a pseudoaneurysm, who was previously managed as a psychiatric case and for musculoskeletal pain. On subsequent investigation and confirmation with cardiac magnetic resonance imaging, aneurysmectomy was done. This is a rare case in a young 22-year-old woman with a ventricular pseudoaneurysm of unknown etiology. Considering the high risk for rupture of a ventricular pseudoaneurysm, surgical resection was mandatory with no complications intra- and post-procedure.

Background Longstanding severe rheumatic mitral stenosis (MS) is associated with changes in the atrial chamber dimensions. It is not known whether there is an increased thickness of the inter-atrial septum (IAS) in patients with severe rheumatic mitral stenosis. The objective of this study was to evaluate pre-procedural IAS thickness by echocardiography in patients with moderate to severe rheumatic mitral stenosis undergoing percutaneous balloon mitral valvuloplasty (PBMV). Methods The thickness of the IAS was measured by transesophageal echocardiography (TEE) in 86 patients between 14 and 65 years of age. Patients with moderate to severe rheumatic mitral stenosis undergoing percutaneous mitral balloon valvuloplasty (PMBV) at the National Institute of Cardiovascular Diseases (NICVD), Karachi were recruited for this study. IAS thickness was measured by TEE using standard views and 3 different phases of cardiac cycles were evaluated. Results Out of 86 patients, almost three fourths (73.3%) were between 14 and 29 years of age and two thirds (62.8%) were females. Mean IAS thickness was 2.56 (SD 0.92) mm at anterior region (AR), 1.89 (SD 0.75) mm at fossa ovalis (FO), and 2.95 (SD 0.97) mm at posterior region (PR). None of the demographic and clinical groups showed any statistically significant difference in IAS thickness. Conclusions Inter-atrial septum (IAS) thickness measurement does not change in the presence of moderate to severe rheumatic mitral stenosis as compared to the reported normal values of IAS thickness in cadaveric hearts.

A left ventricular pseudoaneurysm is formed when there is free wall rupture of the myocardial wall with discontinuity and roof covered by pericardium mural thrombus or fibrous tissue without any myocardium. A left ventricular pseudoaneurysm is a rare and life-threatening event. We report a young 22-year-old female with unknown etiology of a pseudoaneurysm, who was previously managed as a psychiatric case and for musculoskeletal pain. On subsequent investigation and confirmation with cardiac magnetic resonance imaging, aneurysmectomy was done. This is a rare case in a young 22-year-old woman with a ventricular pseudoaneurysm of unknown etiology. Considering the high risk for rupture of a ventricular pseudoaneurysm, surgical resection was mandatory with no complications intra-and postprocedure.

Objectives: To elucidate the involved culprit arteries and proportion of spontaneous arterial recanalization (SAR) in acute lateral wall myocardial infarction (ALWMI) patients in Pakistan. Methodology: This cross-sectional study was conducted in the outpatient department (OPD) of a tertiary care cardiac center from February 2019 to July 2019. Patients meeting selection criteria of ALWMI were included. Key angiographic outcomes were recorded for each patient. Proportion of SAR in terms of involved culprit arteries was assessed. Results: One hundred fifty two (152) patients were included, out of which 81% (124) were males. Mean age was 54.73 ± 11.03 years. Most (46.4%) of the study patients presented with single vessel disease. Overall, 89 (59%) patients showed SAR with settled ECG changes. Of them 73 (66%), 8 (33%) and 8 (47%) patients had diagonal artery involvement, 1st obtuse marginal artery involvement and ramus intermedius artery involvement respectively. Statistical significance (p=0.006) is observed for relationship of involved culprit arteries and SAR in ALWMI patients. Conclusion: This cross-sectional study reports the proportion of arterial recanalization in terms of involved culprit arteries. Diagonal was the culprit artery (~ 73%) in most patients presented with ALWMI. SAR proportion is also highest in patients with diagonal artery involvement. This tendency of SAR was more in single vessel diseases patients compared to double vessel and triple vessel diseases patients.

Objectives: The objective of this survey was to highlight whether influenza vaccination was advised or not in patients with heart failure. Whether heart failure patients are aware of its significance or not, and more importantly they are getting vaccinated or not. Methodology: This descriptive short survey was conducted at heart failure clinic of a tertiary care cardiac center. Consecutive patients of heart failure with reduced ejection fraction (HFrEF) were interviewed regarding awareness and significance of influenza vaccination. Survey was conducted using a structured questionnaire with specific sections pertinent to the demographic details of the participants, clinical history of heart failure and hospitalizations, co-morbid conditions, and awareness and adherence to the influenza vaccination. Results: A total of 60 patients with HFrEF participated in this survey, 71.7% (43) of which were male, overall mean age was 56.82 ± 11.78 years, and mean duration since diagnosis of HFrEF was 3.88 ± 3.66 years. Only 15% (9) of the participants were aware of influenza vaccination, 18.3% (11) recall being advised by the medical officer, and 11.7% (7) received these vaccinations. Conclusion: Influenza vaccination rate in patients with heart failure in Pakistan population is very low. The primary reason is inadequate prescription practice by physicians and lack of adequate awareness. Need of time is to emphasis health care provider to prescribe and encourage their patients with heart failure to receive influenza vaccine and to make it accessible.