AIM: The aim of this study was to compare the safety and efficacy of paclitaxel-coated balloons (PCB) and sirolimus-coated balloons (SCB) in patients with in-stent restenosis (ISR). METHODS: This prospective, observation...AIM: The aim of this study was to compare the safety and efficacy of paclitaxel-coated balloons (PCB) and sirolimus-coated balloons (SCB) in patients with in-stent restenosis (ISR). METHODS: This prospective, observational, single-centre pilot study enrolled 85 patients diagnosed with drug-eluting stent ISR. For all the eligible patients, various clinical baseline characteristics were collected, and angiography was performed to evaluate the lesion characteristics. After assessment, patients were treated with either PCB or SCB based on our center's time-based approach. Intravascular ultrasound (IVUS) imagining was used to assess the pre- and post-procedural minimal stent area (MSA). All the patients were followed up and major adverse cardiovascular events were documented for patients in both the groups. RESULTS: Of total 85 patients with ISR, 32 underwent treatment with PCB and 53 with SCB. A significant difference was noted in the post procedural MSA in both the groups (p = 0.005) and the values were 7.01 ± 1.11 mm and 8.01 ± 1.70 mm for PCB and SCB group, respectively. At median follow-up of 3.8 years, no cardiac death was noted in PCB group and one death was reported in SCB group (p = 0.459). In PCB group, target lesion revascularization (TLR) was noted in one (12.5 %) patient, while in SCB group TLR was noted in four (16.5 %) patients (p = 0.920). CONCLUSION: Both PCB and SCB are found to be effective and safe in treating in patients with drug-eluting stents-ISR. Also, the use of DCB with imaging techniques like IVUS enhances treatment outcomes and optimizes patient care in ISR treatment.
Broad QRS and bundle-branch blocks are associated with poor outcomes in patients with DCM, however, studies on changes in QRS duration and morphology over long-term are limited. We retrospectively analyzed changes in ven...Broad QRS and bundle-branch blocks are associated with poor outcomes in patients with DCM, however, studies on changes in QRS duration and morphology over long-term are limited. We retrospectively analyzed changes in ventricular activation and AV conduction in serial ECGs of 165 DCM patients with a follow-up of at least 5 years from 2003 to 2022. The mean QRS duration at the last follow-up was 114.2 ± 29 vs 106.2 ± 25.3 msec at the baseline(p < 0.0001). Individuals who showed ≥10msec increase in QRS duration also had a higher prevalence of ventricular conduction defects (68%). 13.8% of patients developed broadening of QRS, with an LBBB pattern in over 50%.
OBJECTIVE: M-JBT is a novel approach to the "keep-it-open strategy" for bifurcation lesions where SB anatomy is unsuitable for stenting. We intend to provide insight into a contemporary way through our experience of the...OBJECTIVE: M-JBT is a novel approach to the "keep-it-open strategy" for bifurcation lesions where SB anatomy is unsuitable for stenting. We intend to provide insight into a contemporary way through our experience of the M-JBT. METHODS: A semi-compliant balloon sized appropriately for the SB diameter is inflated simultaneously with the MB stent balloon during stent deployment, followed by POT of the MB stent and then recrossing the SB. RESULTS: We performed the "M-JBT" in 25 cases of bifurcation lesions between September 2023-24, with absolute procedural success in preventing SB occlusion during MB stenting in all 25 lesions. SB occlusion after MB stent POT was seen in one case. CONCLUSION: This is the first report of clinical experience with the MJBT from the Indian subcontinent. MJBT proves to be a safe and effective approach to the protection of a clinically important SB during MB stenting across it.
BACKGROUND AND OBJECTIVE: There is limited data on secondary prevention medications following acute coronary syndrome (ACS) in India. We performed a registry-based study to evaluate adherence to recommended medications f...BACKGROUND AND OBJECTIVE: There is limited data on secondary prevention medications following acute coronary syndrome (ACS) in India. We performed a registry-based study to evaluate adherence to recommended medications following ACS hospitalisation. METHODS: Consecutive patients admitted with ACS were recruited. Data on demographics, baseline characteristics, in-hospital interventions, and prescribed secondary prevention therapies (antiplatelets, statins, beta-blockers, angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and calcium channel blockers (CCB) at discharge were recorded. 6-months follow-up was conducted to evaluate adherence using validated tools. RESULTS: 716 patients were recruited; the mean age was 60.4 ± 11 years, percutaneous coronary angioplasty (PCI) was performed in 714 (99.7 %) and bypass surgery in none. At hospital discharge, the cardioprotective medications were: aspirin 97.3 %, dual antiplatelets 99.7 %, statins 99.7 %, beta-blockers 74.2 %, ACEI/ARB 38.8 % and CCB 10.9 %. Follow-up data were available for 554 patients; 15 (2.1 %) died and 147 (20.5 %) were lost to follow-up. Medication status and change at 6 months was aspirin 83.9 % (-15.9 %); dual antiplatelets 70.2 % (-29.5 %), statins 70.0 % (-29.8 %), beta-blockers 50.4 % (-32.1 %), ACEI/ARB 22.4 % (-42.3 %) and CCB (-36.7 %) (p < 0.05). Use of high-intensity statins declined from 92.0 % to 45.7 % (-50.3 %). At follow-up, good adherence (>80 %) was 42.7 %, low adherence 24.4 % and non-adherence 10.2 %. Patients with government-sponsored insurance had better adherence than privately insured and self-paying. CONCLUSIONS: Following acute coronary syndrome and PCI, the adherence to prescribed pharmacotherapy is sub-optimal at 6 months with a decline in various medications of 16-42 %. Strategies to increase adherence to secondary prevention therapies are required.
The history of coagulation cascade dates back to 17th century. The extrinsic and intrinsic pathways were proposed in 1998. Extrinsic pathway includes the tissue factor and stable factor which activates factor X and with...The history of coagulation cascade dates back to 17th century. The extrinsic and intrinsic pathways were proposed in 1998. Extrinsic pathway includes the tissue factor and stable factor which activates factor X and with help of factor V, this converts prothrombin to thrombin which is stabilised by factor XIII. This helps to seal the bleeding vessel and is a physiological process as there is only "limited" production of thrombin which doe not expand beyond the damaged site due to absence of tissue factor. On the other hand intrinsic pathway is activated by polyanions, neutrophilic extracellular traps which are present during infection and inflammation. These activate factor XI which activates factor X with the help of factor IX and VIII and then the common pathway ensues. But newer discoveries have shown that this is a very simplified way of explaining the coagulation system. The researches propose that haemostasis is divided into initiation, amplification and propagation phase. Also, the factor VII-tissue factor complex formed activates factor IX and leads to sustained thrombin production as the amount of thrombin produced by extrinsic pathway alone is not sufficient to form a haemostatic plug. Thrombin also activates factor XI and lead to self perpetuation of intrinsic pathway. All the anticoagulants have an inherent property of bleeding. So the newer factor XI and XII inhibitors focus to inhibit the excessive thrombin production without hampering the physiological haemostasis process. This is supported by the fact that congenital factor XI and XII deficiency does not cause excessive bleeding but increased levels did make patients more vulnerable to thromboembolism. This review shall focus on the various factor XI and XII inhibitors which are in the pipeline.
BACKGROUND: A widely accepted concept in cardiovascular physiology states that diastole constitutes 62.5 % of the cardiac cycle during a typical 0.8-s cycle at 75 beats per minute. However, this has not been confirmed by...BACKGROUND: A widely accepted concept in cardiovascular physiology states that diastole constitutes 62.5 % of the cardiac cycle during a typical 0.8-s cycle at 75 beats per minute. However, this has not been confirmed by using modern technology in healthy individuals. OBJECTIVE: This study aimed to accurately measure diastolic duration as a fraction of the cardiac cycle using echocardiography in healthy adults with structurally normal hearts. METHODS: In this prospective study, 200 healthy adults aged over 18 years, with heart rates between 50 and 100 beats per minute, normal ECGs, and structurally normal hearts, were included. Using a modified apical 5-chamber view and pulse wave Doppler at the aortic and mitral valves, researchers measured the RR interval (total cardiac cycle), diastolic duration (from aortic valve closure to mitral valve closure), and systolic duration. Three measurements were taken for each parameter, and the mean was used for analysis. RESULTS: Participants had a mean age of 47.7 years (range 19-79), with an equal gender distribution. The mean RR interval was 799 ± 97 ms. The left ventricular (LV) diastolic duration was 469 ± 76 ms, and the LV systolic duration was 330 ± 42 ms. The ratio of diastolic duration to the total cardiac cycle was 0.58 ± 0.04, slightly higher in males (0.59 ± 0.04) compared to females (0.57 ± 0.04). CONCLUSION: This study challenges the longstanding teaching that diastole accounts for two-thirds of the cardiac cycle. Instead, diastole represents 58 % of the cycle, highlighting the need to reconsider its role in cardiovascular physiology and clinical applications.
INTRODUCTION: Contrast induced nephropathy is third most common cause of renal insufficiency following percutaneous coronary angioplasty (PCI) and patients with preexisting renal dysfunction are even at a higher risk for...INTRODUCTION: Contrast induced nephropathy is third most common cause of renal insufficiency following percutaneous coronary angioplasty (PCI) and patients with preexisting renal dysfunction are even at a higher risk for poor outcomes. With the advent of intravascular imaging, safety and efficacy of angioplasty can be improved significantly in these patients. MATERIAL AND METHODS: This observational prospective study included 72 consecutive patients with CKD(eGFR ≤45 ml/min/m) and established CAD who underwent absolute zero contrast PCI at a single tertiary center.PCI was planned in patients with significant stenosis and indications for revascularization.All Procedures were performed under dry fluoroscopy and IVUS guidance without use of any contrast.Informed consent, clinical,procedural and follow-up data was collected and analysed. RESULTS: Total 72 patients (90 vessels) with median age of 63 years and eGFR (34.1 ml/min/1.73 m) underwent zero contrast PCI. Procedure was performed by Femoral (45.6 %)and radial (54.4%) route. Total 11 patients (15.3%) underwent left main stenting. Fluoroscopic landmarks such as side-branch wiring (71.1%),floating wire in aorta (22.2 %), calcifications (21.1%), bony landmarks such as ribs or vertebrae (45.5%) and Sternal wires/clips (6.6%) were used in addition to IVUS to enable more accurate placement of stent.Technical and procedural success were achieved in 91.1% and 97.2% of patients.One patient died in hospital due to non-cardiac cause and one patient required hemodialysis.Post procedure at 48 hrs, there was no deterioration of renal function.On 3 months followup, there was no significant major adverse cardiovascular events (MACE). CONCLUSION: Our study shows that with the help of fluoroscopy landmarks and intravascular imaging, zero contrast PCI can be performed safely with good clinical outcomes in patients at risk of nephropathy.
OBJECTIVES: To study the impact of a 'hub and spoke' STEMI management programme on delivery of thrombolysis in the state of Goa. METHODS: A prospective observational study was conducted to assess the 'hub and spoke' mode...OBJECTIVES: To study the impact of a 'hub and spoke' STEMI management programme on delivery of thrombolysis in the state of Goa. METHODS: A prospective observational study was conducted to assess the 'hub and spoke' model STEMI programme in the state of Goa. Data was collected using predesigned proformas filled at Primary Health Centres or District Hospitals which served as the spokes. Primary programme efficacy outcomes studied were the proportion of eligible patients of STEMI receiving thrombolysis and the time to thrombolysis. Secondary outcome assessed was in-hospital mortality. RESULTS: A total of 2050 number of patients were diagnosed with STEMI between November 2019 and March 2022, of which complete data was available for 1325 patients. After ruling out contraindications, delayed presentations or refusal for treatment, 74.3 % of STEMI patients received thrombolysis. The median window period was 130.83 min with an interquartile range (IQR) of 159.63 min. The median time from presentation to recording ECG was 7.9 (IQR = 11.63) minutes and presentation to cloud diagnosis was 11.78 (IQR = 12.96) minutes. The median time from presentation to administering thrombolysis (Door to Needle time) was 18.48 (IQR = 28.85) minutes. Only 0.22 % patients received inappropriate thrombolysis and the in-hospital mortality was 9.4 %. CONCLUSION: A STEMI programme utilizing the existing manpower and primary health care setup improved 'secondary' level of care to patients by providing thrombolysis to a high percentage of patients in quick time. This may serve as a model to improve the outreach of reperfusion therapy in a resource challenged country like India.
AIMS: To find the incidence, risk factors of Prosthetic Valve Thrombosis (PVT)To study the efficacy, outcome and complications of fibrinolysis in PVT. METHODS: Data from 44 consecutive patients admitted with PVT treated...AIMS: To find the incidence, risk factors of Prosthetic Valve Thrombosis (PVT)To study the efficacy, outcome and complications of fibrinolysis in PVT. METHODS: Data from 44 consecutive patients admitted with PVT treated with fibrinolytics were assessed, outcomes recorded. Only medically managed PVT were included in this study and Surgical management were not included due to inadequate resources. RESULTS: Out of 44 patients, 28 were female and 16 were male with mean age of 36.5 41 had underwent MVR, 3 had underwent DVR. 42 (92.4 %) had thrombus at mitral valve 2 (4.5 %) were at aortic valve. Visible clot was present in 7 (15.9 %) and absent in 37 (84 %) patients. 7 (15.9 %) had recurrent episode of PVT. At the time of thrombolysis, no patient had major bleeding manifestation. During follow up after thrombolysis, 37 (84 %) were alive and 7 (16 %) expired. The incidence of primary end point i.e successful thrombolysis (as defined as complete response without complications) was seen in 61.3 % patients. The secondary end point i.e. Therapeutic failure/death is recorded in 15.9 % study subjects. Among the vulnerable population, therapeutic Failure/death is seen with 57.1 % sub-therapeutic anticoagulant consumers and 42.8 % patients with poor drug compliance. CONCLUSION: In conclusion this study sheds light on the complexities and challenges associated with prosthetic valve thrombosis in pregnant patients, patients with sub therapeutic anticoagulation or poor drug consumers. This study underscores the importance of close monitoring, optimal anticoagulation, patient education. This study highlights that fibrinolysis unless contraindicated can be considered as effective especially in developing countries or in centres with limited resources, where multiple factors such as surgical availability, financial cost, high operative mortality are to be weighed before treatment.
BACKGROUND: Valvular inflammation plays an important role in the progression of Rheumatic Heart Disease. We report the association between inflammatory markers and use of Benzathine Penicillin G in patients with Rheumati...BACKGROUND: Valvular inflammation plays an important role in the progression of Rheumatic Heart Disease. We report the association between inflammatory markers and use of Benzathine Penicillin G in patients with Rheumatic mitral valve disease. METHODS: The levels of inflammatory cytokines; IL-1β, IL-6, TNF-α and inflammatory marker hs- CRP were measured using ELISA method in 32 patients with RHD receiving Benzathine Penicillin as secondary prophylaxis and 31 patients not receiving secondary prophylaxis, in a case-control study. The severity and type of valvular dysfunction were assessed with echocardiogram. RESULTS: The median level of IL-1β was significantly lower in patients on BPG (0.95 pg/ml vs. 5.47 pg/ml) p < 0.002. The median levels of IL-6, TNF-α and hs-CRP were not significantly different between study groups. The adjusted odds of raised IL-1β were lower in patients on BPG (odds ratio 0.40, 95 % C.I. 0.11, 1.45) p 0.16. There was a trend of inverse association between the use of BPG and mitral stenosis (odds ratio 0.42, 95 % C.I. (0.12, 1.46) p 0.17. CONCLUSION: Patients with RHD on BPG had lower levels of IL-1β and a trend toward a lower prevalence of mitral stenosis. Role of IL-1β in progression of incompetent to stenotic mitral valve dysfunction needs to be explored in future studies.
BACKGROUND: No/slow flow after percutaneous intervention(PCI) for acute coronary syndromes (ACS) is common. Whether a comprehensive intravascular ultrasound (IVUS) analysis of atherosclerotic plaque can define characteri...BACKGROUND: No/slow flow after percutaneous intervention(PCI) for acute coronary syndromes (ACS) is common. Whether a comprehensive intravascular ultrasound (IVUS) analysis of atherosclerotic plaque can define characteristics which predict suboptimal flow following PCI is largely unknown. OBJECTIVES: To identify IVUS correlates of suboptimal flow in patients with ACS undergoing PCI. MATERIALS & METHODS: We performed a prospective multicentre, investigator initiated study. Patients with ACS, who underwent IVUS guided PCI were enrolled. Clinical, angiographic and imaging characteristics of patients who developed suboptimal flow after PCI were analysed and compared with patients with normal flow. RESULTS: Between October 2021 and August 2022, we enrolled 187 patients (195 lesions) with ACS who underwent IVUS guided PCI. Mean age of patients was 58 ± 10.4 years; Incidence of slow/no reflow in our study was 14/195 (7.2 %). Presentation as ST elevation myocardial infarction, presence of angiographically complex lesion type (type B2/C) and pre procedural TIMI flow 0 were significantly more in patients who developed suboptimal flow after PCI. Pre PCI plaque attenuation length (9.51 mm Vs 4.35 mm p = 0.037), lesion site positive remodelling (Odds ratio 6.4 : 95 % CI; 1.1-38.4 p = 0.042) were predictors of slow flow.Post PCI length of plaque prolapse (9.73 mm Vs 6.58 mm p = 0.029) correlated with slow flow. CONCLUSIONS: Plaque characteristics on IVUS in patients with ACS helps to identify patients who may develop suboptimal flow following PCI.
OBJECTIVES: High thrombus burden during Primary Percutaneous Coronary Intervention begets poor outcomes; there are several lacunas in the management of those patients.- The purpose of this study is to analyse the long-te...OBJECTIVES: High thrombus burden during Primary Percutaneous Coronary Intervention begets poor outcomes; there are several lacunas in the management of those patients.- The purpose of this study is to analyse the long-term outcomes of patients undergoing primary percutaneous coronary intervention with high thrombus burden, treated with intracoronary thrombolysis as an adjunctive therapy. METHODS: In this prospective observational study, 108 consecutive primary percutaneous coronary intervention patients with high thrombus burden were stratified into two groups basing on whether they received intracoronary thrombolytic agent before stent implantation. The primary outcome is Net Adverse Clinical Events. Secondary outcomes include Major Adverse Cardiac Events, and all other individual components of the Net Adverse Clinical Events when analysed separately. RESULTS: The primary outcome events occurred in 21 patients (26 %) in the Primary stent group (n = 80), whereas it occurred in 2 patients (6 %) in the primary intra-coronary thrombolysis group (n = 28), this study shows that there is no difference in primary endpoints in both groups (26 % Vs 7 %, p-value - .042, Hazard ratio - 2.56; 95 % CI - .76-8.57), however Kaplan-Meier event-free survival curves show that both the curves are well separated apart even at the end of the one year of follow - up. CONCLUSION: There is no difference in the primary outcome events in both groups, however there was a consistent increase in events in the primary stent group over the one-year follow-up period. These findings suggest the need for a larger randomized clinical trial to confirm and further elucidate these results.
Industry's influence on clinical trials is well known and extends to various aspects beyond funding, including industry-affiliated authors and industry-affiliated analysts. An area of potential concern is presentation of...Industry's influence on clinical trials is well known and extends to various aspects beyond funding, including industry-affiliated authors and industry-affiliated analysts. An area of potential concern is presentation of analyzed data that does not appear favorable to the desired study outcome. Such important data are at times not accorded prominence in discussion. The present article analyses such concerns in data presentation in the landmark trials of two cardiac devices the use of which has increased markedly in recent years (DanGer Shock trial and COAPT trial). It is seen that important data that did not appear favorable to the intended study outcome were relegated mostly to Supplement Section, where they are likely to receive less attention, with little discussion allocated in the text.
Cardiovascular disease (CVD) is a major driver of mortality and declining health worldwide. Cardiovascular diseases (CVD) is the most common cause of morbidity and mortality globally. Although dyslipidemia, smoking, diab...Cardiovascular disease (CVD) is a major driver of mortality and declining health worldwide. Cardiovascular diseases (CVD) is the most common cause of morbidity and mortality globally. Although dyslipidemia, smoking, diabetes, hypertension and obesity are some well-known causes of CVD, the overlapping genetic pathways between other diseases and those affecting cardiovascular health have been overlooked. In the past decade, mutations in TET2, DNMT3A, ASXL1, and JAK2 are found to cause clonal hematopoiesis of intermediate potential (CHIP), a disease associated with age-related haematological malignancies without the presence of cytopenias or dysplasia. Coronary artery disease, heart failure, aortic stenosis, and arrhythmias have been shown to be associated with the presence of CHIP mutations. Addressing the association between CHIP could significantly reduce residual risk patients with CVD. The link between CHIP and CVD can potentially be addressed through inhibitors of inflammasomes, antagonists in the interleukin pathway, or direct antagonists of CHIP mutations.
BACKGROUND: Cardiac catheterization via the trans-radial approach (TRA) has shown several advantages over the trans-femoral approach (TFA) but with a concern of higher radiation exposure. Considering the growing experien...BACKGROUND: Cardiac catheterization via the trans-radial approach (TRA) has shown several advantages over the trans-femoral approach (TFA) but with a concern of higher radiation exposure. Considering the growing experience with TRA, this study compares patient's radiation during coronary angiography using TRA versus TFA. METHODS: This study included consecutive patients undergoing coronary angiogram over a year at tertiary hospital performed by experienced operators through radial or femoral access. Parameters compared between the two routes included fluoroscopy time (FT), cineangiography time (CT), cini-sequences (CS), and patient radiation exposure quantified by Air Kerma (AK) and Dose Area Product (DAP). RESULTS: A total of 910 patients were studied, with 461 (50.6 %) undergoing coronary angiography (CAG) via TFA and 449 (49.4 %) via TRA. The mean age was similar between the femoral (54.07) and radial groups (53.7) years (p = 0.33), with slightly lesser proportion of males in the femoral group (74.62 % vs 79.73 %; p = 0.06). The mean (SD) DAP and AK were 15.71 (7.05) Gy·cm and 258.3 (99.9) mGy for the femoral group, compared to 20.76 (9.48) Gy·cm and 352.2 (151.5) mGy for the radial group (both p < 0.001). The mean (SD) FT, CT, and CS were 1.32 (0.94) minutes, 40.4 (9) seconds, and 5.93 (1.22) for the femoral group, compared to 2.19 (1.67) minutes, 44 (10) seconds, and 6.17 (1.26) for the radial group (all p < 0.01). CONCLUSION: Coronary angiography via TRA is associated with increased patient's radiation. Future studies should investigate strategies to reduce radiation exposure in trans-radial procedures.
It is not well-known if valve replacement outcomes differ in patients with sarcoidosis, especially in aortic valve intervention, where the pressure gradients are physiologically high. In this retrospective study, we incl...It is not well-known if valve replacement outcomes differ in patients with sarcoidosis, especially in aortic valve intervention, where the pressure gradients are physiologically high. In this retrospective study, we included all patients who underwent surgical/transcatheter aortic valve replacement from the Nationwide Readmission Database (2016-2019), and then divided them into those with and without sarcoidosis. Logistic and cox proportional hazard regression models were used. In-hospital mortality, stroke, acute kidney injury, paravalvular leak, 30-day pacemaker implantation, and 30-day heart failure readmission were similar in patients with and without sarcoidosis. Thus, sarcoidosis did not affect the clinical outcomes in patients undergoing aortic valve replacement. Further prospective studies are needed in this patient subgroup to support clinical decision-making.
Angiotensin Receptor Neprilysin Inhibitor (ARNI) has not shown to be promising in Heart failure with preserved LVEF. Role of ARNI in Right ventricular systolic dysfunction with preserved LVEF needs to be evaluated. We to...Angiotensin Receptor Neprilysin Inhibitor (ARNI) has not shown to be promising in Heart failure with preserved LVEF. Role of ARNI in Right ventricular systolic dysfunction with preserved LVEF needs to be evaluated. We took 50 patients with isolated RV systolic dysfunction and divided them into two groups of 25 patients each- Conventional treatment and ARNI in addition to conventional treatment. We found that the ARNI group showed a significant improvement in NYHA class, all the echo parameters of RV size, RV function and NT-pro BNP levels at 4 weeks and 12 weeks.
Das MK, Malviya A, Zachariah G
… +11 more, Ramakrishnan S, Jabir A, Nair VK, Bardoloi N, Sinha DP, Banrjee PS, Shanmugasundaram S, Wander GS, Kahali D, Roy D, Yadav R
BACKGROUND: Various studies have documented gender differences in the management and outcomes of acute myocardial infarction (AMI) in developed countries. Gender differences in the management of AMI in India is not known...BACKGROUND: Various studies have documented gender differences in the management and outcomes of acute myocardial infarction (AMI) in developed countries. Gender differences in the management of AMI in India is not known. OBJECTIVES: To document the gender differences in the management and outcomes of AMI in India. METHODS: The current study was a nationwide retrospective, multicenter, cross-sectional study including all consecutive AMI patients admitted from 15th March to 15th June in the year 2020 using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. RESULTS: There were only 9018 females (21.6 %) among the 41832 patients with AMI in the study. Females were older and were more likely to present with non ST-elevation MI than men (41.6 % vs. 33.2 %). Significantly fewer number of females underwent primary percutaneous coronary intervention (29.5 % vs 31.2 % p value < 0.001), thrombolysis (32.9 % vs 34.7 %, p value < 0.001), pharmaco-invasive therapy (18.6 % vs 20.7 % p value 0.001). Females had higher in-hospital mortality (7.07%vs 4.07 %, p < 0.001), length of hospital stay (3.9 ± 2.98 days vs 3.8 ± 2.88 days, p < 0.001) and complications of AMI [cardiogenic shock (8.6 % vs 6.3 %), mechanical complications (4.6 % vs 3.8 %), heart failure (13.9%vs 11.7 %) and malignant arrhythmias (3.4%vs2.8 %)] than males. CONCLUSIONS: Differences between gender in the presentation, management, and outcomes of acute MI are prevalent in India. Women with acute MI presented at older age, had higher in-hospital mortality and complications, and received revascularization therapy less often compared to men.
BACKGROUND: Future clinical management would be improved by accurate and early identification of ACS patients at high CV risk. In non-valvular atrial fibrillation patients, the prognostic risk of thromboembolism has been...BACKGROUND: Future clinical management would be improved by accurate and early identification of ACS patients at high CV risk. In non-valvular atrial fibrillation patients, the prognostic risk of thromboembolism has been evaluated using CHA₂DS₂-VASc scores. It has recently been shown to assess the severity of CAD and foresee patient outcomes. Also, LV global longitudinal strain is an independent predictor of outcome. Our study aimed to determine the added value of LV longitudinal strain (GLS) to CHA₂DS₂-VASc in predicting the outcome and severity of CAD in patients with acute coronary syndrome (ACS). METHODS: A total of 577 patients with primary diagnosis of ACS were included between January and July 2021. All patients had evaluations based on history, clinical examination, 12-lead ECG, TTE, and coronary angiography. Six months follow-up had been provided to all patients. RESULTS: Syntax score was significantly higher among patients with high-risk CHA₂DS₂-VASc score (30.5 ± 6.1 vs. 17.34 ± 8.7 vs. 11.11 ± 8.2), p-value <0. 001. GLS was significantly lower among high SYNTAX score (-10.97 ± 2.68 vs. -12.61 ± 3.46 vs. -17.81 ± 2.89), p-value = 0.0001. There was a significant negative correlation between the CHA₂DS₂-VASc score and GLS. Moreover, adding GLS to CHA₂DS₂-VASc score significantly improved overall accuracy for the prediction of outcome and severity of CAD in ACS patients. CONCLUSIONS: CHA₂DS₂-VASc score is an easy and simple parameter that can be used in predicting the severity of CAD & adverse clinical outcome in ACS patients and adding GLS to the CHA₂DS₂-VASc score significantly improved overall accuracy.