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Objective: To study the frequency of In-Stent Restenosis and its treatment in patients undergoing Percutaneous Coronary Intervention for coronary artery disease. Study Design: Descriptive cross sectional study. Place and Duration of Study: Department of Cardiology, Armed Forces Institute of Cardiology & National Institute of Heart disease (AFIC/NIHD) Rawalpindi, from Jul 2017 to Jul 2019. Methodology: All the patients who underwent Percutaneous Coronary Intervention for Coronary Artery Disease at our institute were considered for this study. A consecutive sampling method was used and inclusion/exclusion criteria was applied. Following data was obtained; 1) Demographic information and clinical risk factors like history of hypertension, hyperlipidemia, diabetes mellitus, smoking, coronary artery disease characteristics (number of diseased arteries, bifurcation lesions, calcification, chronic total occlusions-CTO and tortuosity) 3), Stent factors (under expansion, fracture, longitudinal miss, stent gap). Data recording, storage, assessment and analysis was done by using SPSS software version 21. Results: Among 1332 cases, 50 had In-Stent Restenosis with overall prevalence of 3.75%. Mean age of the patients with In-Stent Restenosis was 58.76 (± 9.97), with 45 (90%) male and 5 (10%) female. Diabetes Mellitus was the commonest risk factor (22.9%) followed by Hypertension (18%). Sixty four percent of the patients (n=32) had Single Vessel Coronary Artery Disease, 14 (28%) had Double Vessel Coronary Artery Disease and 4 (8%) had Tripple Vessel Coronary Artery Disease. Left Anterior Descending was the commonest coronary artery that developed In-Stent Restenosis, followed by Right Coronary Artery and Left Circumflex respectively. Previously deployed stents which developed In-Stent Restenosis showed longitudinal geographical miss in 16%, stent under expansion in 6% and stent gap in 4%. There was statistically significant association (p-value=0.02) between stent length and frequency of In-Stent Restenosis and it was commonest in stents longer than 30 mm. Eighty six percent (n=43) of In-Stent Restenosis cases in our study group was treated with Drug Eluting Stent followed by Drug Eluting Balloon in 32% and Plain Old Balloon Angioplasty in 22%. Conclusion: History of diabetes mellitus and greater stent length were major risk factors in developing In-Stent Restenosis in our study. DES was the commonest treatment modality used. [ABSTRACT FROM AUTHOR]

Objective: To study the HRCT chest findings in patients undergoing cardiac interventions during COVID-19 era. Study Design: Cross sectional analytical study. Place and Duration of Study: Armed Forces Institute of Cardiology & National Institute of Heart Disease (AFIC/NIHD) Rawalpindi, from Apr 2020 to May 2020. Methodology: All the admitted cardiac patients who were to undergo any invasive cardiac intervention underwent plain HRCT chest and polymerase chain Reaction (PCR) for SARS-CoV-2 simultaneously. One hundred and ten patients were studied. We analyzed preexisting respiratory illnesses, clinical, echocardiographic and radiological features. Data recording, storage, assessment and analysis was done by using SPSS-21. Results: Our study included 110 patients (87 Male, 23 Female, median age 52 Years). Common reasons for admission were coronary angiography 43 (39.1%), acute Left Ventricular Failure (LVF) 30 (27.3%), Percutaneous Coronary Intervention (PCI) 13 (11.8%) and chest pain evaluation 10 (9.1%). Cardiomegaly (29.1%) followed by consolidation (9.1%) were commonest radiological finding. Two third patients had abnormal HRCT chest but only few had radiological findings either suspicious (6.4%) or indeterminate (11.8%) for COVID-19. Respiratoy symptoms, positive PCR for COVID-19 and severe Left ventricular dysfunctions were correlated with abnormal HRCT findings, correlation being statistically significant (p-value <0.05). Conclusion: HRCT chest is a non-invasive and highly sensitive imaging modality, which can rapidly help in identifying, and isolating suspected cases of novel corona virus as well as in diagnosing unknown pre-existing lung diseases in cardiac patients. [ABSTRACT FROM AUTHOR]

Objective: To study the frequency, associated risk factors and morphological distribution of Coronary Artery Ectasia (CAE) and Coronary Artery Aneurysm (CAA). Study Design: Descriptive cross sectional study. Place and Duration of Study: Department of Cardiology, Armed Forces Institute of Cardiology & National Institute of Heart disease (AFIC/NIHD) Rawalpindi from Jul 2018 to Jul 2019. Methodology: All patients who underwent Primary Percutaneous Coronary Intervention (PCI) for ST elevation Myocardial Infarction (STEMI) at our institute were considered for this descriptive cross sectional study. A consecutive sampling method was used and inclusion/exclusion criteria was applied. Number of patients having ectatic coronary arteries, ectasia distribution and morphological classification was done by trainee researcher after studying the coronary angiograms. Demographic information, symptoms and risk factors were also documented. Data recording, storage, assessment and analysis was done by using SPSS software version 21. Results: A total 1354 patients diagnosed with STEMI underwent PPCI during the study period and Coronary Artery Ectasia (CAE) was diagnosed in 31 patients (2.2%), out of that 5 (16.13%) patients had Coronary Artery Aneurysm (CAA). Mean age of patients was 58.32 (± 11.22). Hypertension was the commonest preexisting risk factor 9 (29%) followed by Diabetes Mellitus (DM) 4 (12.9%). Left Anterior Descending (LAD) artery was ectatic vessel in majority of our study group. Ectatic coronaries were classified as fusiform 20 (64.52%) and saccular 11 (35.48%) on the basis of shape and in type 1-4 (type 1=16.13%, type 2=35.48%, type 3=32.26%, type 4=16.13%). Statistically significant association (p-value=0.003) was found between infarct related artery and the ectatic artery. Conclusion: CAE has low prevalence in STEMI patients but it has statistically significant association with infarct related artery. Hypertension is a common risk factor. Ectasia has a predilection for both LAD and RCA in our study group. [ABSTRACT FROM AUTHOR]