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Objective: To study the outcome of concomitant treatment of a non-chronic total occlusion lesion at the time of chronic total occlusion intervention at AFIC-NIHD. Study Design: Observational study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi, from Nov 2020 to Apr 2021. Methodology: A total of 171 patients presenting with chronic total coronary occlusion lesions were enrolled in study. Patients were randomized into two groups, group one with chronic total coronary occlusion only group and group two with combined group (chronic total coronary occlusion with non-chronic total coronary occlusion lesion) after coronary angiogram. The primary end-point assessed was angiographic (<30% residual diameter stenosis), clinical and procedural outcomes (TIMI grade flow, major adverse cardiac events (MACE) including death, stent thrombosis (ST), MI, repeated symptoms requiring repeat target vessel revascularization (TVR) either PCI or CABG, pericardial tamponade requiring pericardiocentesis or surgery and stroke) in patients with only chronic total coronary occlusion PCI group and combined group (chronic total coronary occlusion with non-chronic total coronary occlusion). Results: A total of 171 patients with chronic total coronary occlusion lesions were enrolled in the study. The mean age was 60.61 ± 9.68. There was no significant difference in perihospital complications, MACE in the two groups. However, there was increased contrast volume and radiation used in the combined group. Conclusion: Combined chronic total coronary occlusion and non-chronic total coronary occlusion lesion PCI can be done in a single procedural setting with acceptable complications and high success rate. [ABSTRACT FROM AUTHOR]

Objective: To determine whether a planned 2-stent double kissing crush technique is superior to provisional stenting patients presenting with true distal LM bifurcation lesions. Study Design: Cross-sectional comparative study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: A total of 70 patients enrolled in the study presented with true distal LM bifurcation lesions (Medina 1, 1, 1 or 0, 1, 1). Patients were randomized to PS or DK crush technique. The primary end-point was peri hospital and 1 month composite rate target lesion failure (TLF): target vessel myocardial infarction (TVMI), cardiac death, stent thrombosis (ST), target vessel revascularization (TVR). Routine clinical follow up done at 2 weeks and 4 weeks followed by 3 and 6 months thereafter. Results: A total of 70 patients fulfilling the inclusion criteria were enrolled in the study. The patient population was divided into two groups. Group A participants underwent DK crush technique while group B participants underwent provisional stenting. In group A [DK crush technique] 16 (45.7%) patients presented with Non-ST elevation MI followed by 14 (40%) who presented with chronic coronary syndrome (CCS) while in group B [Provisional stenting] 13 (37.1%) presented with chronic coronary syndrome followed by 9 (25.7%) who presented with non-ST elevation MI. Conclusion: LM-PCI is an acceptable procedure in patients with true distal LM bifurcation lesions who are candidates for PCI. This study also showed that DK-Crush has good periprocedural and angiographic outcomes and superior to PS in complex LMCAD lesions. PS is an acceptable option in simple distal LMCAD. [ABSTRACT FROM AUTHOR]

Objective: To share our experience of percutaneous trans-catheter aortic valve implantation TAVI in patients with severe symptomatic aortic stenosis. Study Design: A retrospective cross sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) Rawalpindi, from Mar 2015 to Aug 2019. Methodology: Sixteen patients have undergone transcatheter aortic valve implantation since 2015 in the institute. Base line blood chemistry including creatinine clearance, ultrasonography abdomen, carotid Doppler, CXR, HRCT chest was done in all cases as part of the protocol. All patients under went procedure through transfemoral route. Valve structure and peripheral vasculature for suitability of the procedure was assessed by computerized coronary tomographic angiography (CCTA) with TAVI protocol. Procedure was carried out under general anesthesia in all patients except one. Results: Sixteen patients underwent the procedure successfully with reduction of the mean gradients immediately after valve implantation to less than 15mmHg recorded in the cath lab angiographically subsequently complemented by echocardiography. There were 2 deaths during the index hospitalization. Both occurred in the cath lab, one death was due to development of severe acute aortic regurgitation and second was due to acute coronary obstruction. Four patients died in next three months during follow up. One patient required permanent pacemaker because of development of left bundle branch block and second degree atrioventricular (AV) block post procedure. Conclusion: Transcatheter aortic valve implantation in patients with severe symptomatic aortic stenosis is a very effective and safe procedure and reasonable alternative to surgical valve replacement in high operative risk individuals. [ABSTRACT FROM AUTHOR]