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Background: Aim of the study was to evaluate the primary in-hospital success and 30-days survival outcome of PCI in patients with CTO lesions, using either Bare-metal stents (BMS) or Drug Eluting Stent (DES) like Sirolimus-eluting or Paclitaxel-eluting stent in our hospital setting. Methods: Total 50 patients were randomized as per the definition of CTO, from a total of 400 patients who had PCI at our center in the quantifying period. After the guidewire crossing and the balloon dilation, measurement of the culprit lesion was done by using Siemens QCA measuring system. Among the patients, Male: 41 and Female: 9. Mean age were for Male: 53.3yrs, for Female: 64.4 yrs. Associated CAD risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking. Results: Our study results show 50 patients (12.5%) had CTO lesion out of total 400 PCI procedures. Sex distribution in male 41 (82%), Female 9 (18%). Among the study group; 38 (76%) were Dyslipidemic, 31 (62%) were hypertensive; 20 (40%) patients were Diabetic, 9 (22%) were all male smoker, 5 (10%) were having positive FH for CAD. Female patients were more obese and developed CAD in advance age (male: 53.5 Versus Female: 64.4 yrs). Average diameter of stented vessel was greater in RCA than LAD and LCX. We found that the incidences of CTO lesions were more in LAD territory 20 (40%) followed by RCA 17 (34%) and LCX 13(26%). Single vessel Disease (SVD) in 45 (90%) patients was more common type of CTO lesion followed by Double vessel disease (DVD) in 5(10%). Post procedural, in-hospital and 30 days survival out comer was 100% in our present study. Conclusion: Our study has revealed that PCI in patients with CTO lesions has increased inhospital and 30 days survival outcome, are treated with BMS or DES. The incidence of CTO lesion is more common in male than in female. Female are developing heart disease in advance age and are more obese. Keywords: Chronic total occlusion; PCI; Drug Eluting Stent; Bare Metal Stent DOI: 10.3329/cardio.v2i2.6634 Cardiovasc. j. 2010; 2(2) : 168-174

Background: Majority of the patients of coronary heart disease (CHD) in our country are above 40 years of age but a good number of patients belong to the age under 40, the most valuable and productive period of life during which they can devote themselves to uplift their family, society and country and can participate in nation building activities. 3,4 The number of young individuals falling into the spectrum of CHD is increasing everywhere However, this age trend is peculiar in relation to the western age incidence. 5 Our objective was to investigate the lipid profile and coronary angiographic pattern in young Bangladeshi patients with acute coronary syndrome and also to find out the relationship between dyslipidemia and coronary artery disease in this age group. Methods: This observational study was carried out in National Institute of Cardiovascular Diseases (NICVD) during the period of January 2000 to December 2000. A brief history was recorded on the date of admission and fasting lipid profile was done within 24 hours of admission. Other associated major risk factors were looked for and recorded accordingly. After stabilization oh the acute condition patient was prepared for coronary angiogram and informed consent was taken. Accordingly elective CAG was done. Among them total 64 patients of ACS, underwent coronary angiogram in the cath lab of NICVD, were selected randomly of which of which 32 patients were up to the age 40 years (Group- I) and 32 were above 40 years of age (Group-II). Patient of ACS of either sex having no age limitation were included without prior history of Percutaneous Coronary Intervention or Coronary Artery Bypass Graft surgery. The findings were reviewed and scrutinized carefully by two interventional cardiologists. In doubtful cases third expert reviewed the CD. If a consensus was not reached due to technical or visual error, the case wais discarded from the study. Details of CAG findings i.e. site and number of diseased vessels, location, morphology and pattern of lesion were studied and recorded accordingly. Results: The prevalence of dyslipidaemia and positive family history were more in group I than group II. Younger age group has less favorable lipid profile than older age group having raised total cholesterol in 31.3 percent cases, low HDL in 12.5 percent cases and raised LDL in 31.3 percent cases, while in older age group, it was 21.8, 25.0, 0 and 18.7 percent, respectively. CAG study of the patients showed that no vessel involvement was more common in group I than group II (21.9% vs 12.5%), but triple vessel disease was more common in group II (12.5% vs 21.8%). Single vessel and double vessel diseases were similar in both the groups. Involvement of LAD was slightly more in-group I than group II (68.8% vs 65.6%) and involvement of LCX and RCA were less in group I than group II (21.9% vs 34.3%, and 43.8% vs 78.1%, respectively). Diffuse LAD and RCA lesions were more in group II (36.4% vs 52.4% and 42.9% vs 48.0%, respectively), but diffuse LCX lesion was more in group I (42.9 vs 36.4%). Multiple irregular lesions are more common in older age group (53.1%) than younger age group (28.1%). Conclusion: The younger age group has less favorable lipid profile than older age group having raised total cholesterol, decreased HDL and raised LDL. CAG findings show that most of the lesions are present in LAD (having less impressive LVEF) as like as in older age group, but older age group has more multiple irregular lesions. Prevalence of >2 lesions in one coronary artery was more in group I (31 vs. 25%) but difference was not statistically significant. Keywords: Lipid profile, Coronary angiogram, Younger patients, Acute Coronary Syndrome. DOI: http://dx.doi.org/10.3329/cardio.v1i2.8237 Cardiovasc. j. 2009; 1(2): 183-188

After its introduction by Andrew R. Gruentzig in 1977 percutaneous coronary intervention (PCI) is widely utilized in the treatment of symptomatic coronary artery disease. Though it has numerous benefits, serious and potentially life-threatening complications of PCI can occur, including iatrogenic coronary artery dissection and perforation. The incidence of these complications has been augmented by the development of coronary interventional devices intended to remove or ablate tissue. Here we review the classification, incidence, pathogenesis, clinical sequelae and management of coronary artery dissection and perforation in the current era due to PCI. Specifically, the current angiographic classifications of coronary artery dissections and perforations are reviewed. The findings of several recent, registries of PCI-related coronary artery perforations and dissection are summarized. The management of coronary artery dissection and perforation is discussed in details, including the application of newer modalities such as covered stents. Keywords: Percutaneous coronary intervention (PCI); Coronary artery dissection DOI: http://dx.doi.org/10.3329/cardio.v3i2.9198 Cardiovasc. J. 2011; 3(2): 239-247

Angioplasty opened the stenotic coronary artery but faced complication like abrupt vessel closure. Deployment of bare metal stent within the lesion solved the problem but another complication like restenosis emerged. Neointimal hyperplasia and vessel wall remodeling were identified as the underlying mechanism and lead to the development of drug eluting stent. In the selected patient group, drug eluting stent (sirolimus and paclitaxel) are proved to be extremely promising in respect to reduction of target vessel failure, clinical restenosis (target vessel revascularization), binary restenosis, stent thrombosis and other parameters. Importantly initial positive outcome persisted in the subsequent later follow ups. Outcome in the unfavourable groups are also encouraging but needs few more studies and follow ups. There are scopes for future improvement also. With the immense success, drug eluting stents are increasingly used worldwide and becoming an integral part of percutaneous coronary intervention. (J Bangladesh Coll Phys Surg 2007; 25 : 86-91)

Several Studies have reported specific factors associated with increased risk of adverse outcome following balloon angioplasty. These factors include advanced age, female Sex, unstable angina, congestive heart failure, diabetes and multivessel Coronary artery disease. By this time, Studies have been shown the remarkable procedural success & minimum adverse outcomes following multivessel stenting. This comparative observational study shows no death, procedural MI, tamponade, cerebrovascular accident, heart failure or cardiogenic shock, vascular access site complications like bleeding, A-V fistula in any group (single vessel stenting vs multivessel stenting). However, minor adverse events occurred at an overall rate of 6% in single vessel stenosis (SVS) group & 12% in multivessel stenosis (MVS) group. Procedural results were also similar in both groups. Angiographic success of 100% in the SVS group & 98% in the MVS group noted. The difference in the outcomes were between the two groups was not significant. Key Words: Adverse Outcomes; Multivessel Coronary Stenting; Procedural Results DOI: 10.3329/uhj.v5i2.4557 University Heart Journal Vol.5(2) July 2009 pp.66-70

This is an ongoing study done in National Institute of Cardiovascular Diseases (NICVD) during the period April 2002 to October 2007, few cases were done in Eurobangla Heart Hospital, Lab Aid Cardiac Hospital & National Heart Foundation, SSMC & MH, Metropolitan Medical Center. Total number of study population was 600 with male 550 & female 50. Indication of Percutaneous coronary intervention (PCI) was- Unstable angina (with no prior myocardial infarction) 240 cases, MI inferior (with post Myocardial infarction angina) 204 cases & MI anterior (with post MI angina) 156 cases. The risk factors were Hypertension (HTN) 310 cases (52%), smoking 426 cases (71%), Diabetes Mellitus (DM) 180 cases (30%), Positive family history for ischemic heart diseases (IHD) 120 cases (20%), Hyperlipidemia 150 cases (25%). Total number of target coronary arteries was 760 and total number of lesion was 803 of which780 lesions treated. Distribution of 803 lesions were left anterior descending coronary artery (LAD) 389 (proximal LAD 152, mid LAD 177, distal LAD 60), Right coronary artery (RCA) 230 (proximal 94, mid RCA 93, Distal RCA 26, RCA PD 17), Left circumflex coronary artery (LCX) 137 (proximal LCX 60, mid LCX 54, distal LCX 16, LCX PD 07), diagonal 15, obtuse marginal (OM) 20, ramus intermedius. Angiographic diagnosis of the patients were Single vessel disease 312 (52%), Double vessel disease 156 (26%) & Triple vessel disease 132 (22%). Number of lesions treated were 803 of which 780 lesions was treated. PTCA with stenting done in 725 lesion & 34 lesions treated with plain PTCA. Total occlusion was treated in 85 cases. The native vessel has a mean reference diameter was 3.03 ± 0.61 mm. Residual stenosis after deploying stents was

Chronic total occlusions (CTOs) are commonly found on diagnostic angiography, and successful percutaneous coronary intervention leads to an improvement in long-term survival rates. This study was done in the University Cardiac Center, Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2005 to December 2009. The aim of this study was to examine the trends in angiographic success, clinical success, procedural success and in-hospital outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Total 60 patients (male: female, 11:1) with Mean age 48±10 years were studied. 36 (60%) patients had prior myocardial infarction and all of them had angina (CCS-III, IV). Mean length and reference diameter of the CTO lesion was 19.7±10.4 mm and 2.8±0.5 mm respectably. Clinical success, angiographic success and procedural success rate was (78.3%), (80.0%) and (66.7%) respectably. In hospital adverse outcomes were acute myocardial infarction (5.0%), acute left ventricular failure (6.7%) and malignant arrhythmias (VT, VF) (10.0%). PCI was failed in (11.7%) cases and there was acute in-stent thrombosis in (1.7%) cases. In conclusion it is possible to obtain a relatively high success rate of PCI and favorable clinical outcomes for patients with coronary CTO lesions. Key words: Chronic total occlusions; In hospital adverse outcomes; Percutaneous coronary interventionDOI: 10.3329/uhj.v6i1.7183University Heart Journal Vol.6(1) 2010 pp.13-17

Day by day with the experiences and advancement in technology angioplasty has become more refined with higher rate of success and lower rate of complications. In spite of these there remain some of adverse outcomes following procedure. To minimize procedural complications and adversities were looked for evaluation of high risk features. Percutaneous coronary intervention related mortality is directly related to the episode of coronary artery occlusion and is associated with pronounced left ventricular failure. The variables associated with increased mortality include type C lesion , advanced age, female gender, diabetes, ST segment elevated myocardial infraction ,prior myocardial infraction, multivessel disease, left main or equivalent coronary disease, a large area of myocardium at risk, preexisting impairment of left ventricular or renal function, post- percutaneous coronary intervention worsening of renal function, and collateral vessels supplying significant areas of myocardium that originate distal to the segment to be dilated. Key words: Predictors of coronary intervention, Coronary artery disease DOI: http://dx.doi.org/10.3329/cardio.v1i1.8216 Cardiovasc. j. 2008; 1(1) : 72-77

This prospective ongoing study conducted in University Cardiac Center, BSMMU, Dhaka from July 2004 to April 2006. 100 patients (mean age 52.4±6.2 years) underwent Percutaneous Transluminal Coronary angioplasty and stenting (PTCA & stenting) were evaluated. This study was designed to evaluate the short term angiographic and clinical results of stentangioplasty during hospital stay. The study group of 100 patients consisted of 88 (88%) men and 12 (12%) women. About risk factors 36 (36%) had hypertension, 30 (30%) were smoker, 20 (20%) suffered from diabetes mellitus, 14 (14%) had family history of ischaemic heart disease. Average Left ventricular ejection fraction was 54.2±7. Target vessel PTCA were done on 130 vessels, intracoronary stent implanted in 124 vessels, direct stenting was done in 80 cases, failed PTCA were in 4 (4%) cases, and three patients had dissection. The native vessels had a mean reference diameter of 2.89 mm and their luminal diameter increased significantly after percutaneous coronary intervention (PCI). Thombolysis in myocardial infarction (TIMI) flow analysis showed most of the patients had TIMI-1 flow (95,73%) before the procedure and maximum patients achieved TIMI-3 flow (91, 70%) after the procedure with significant clinical improvement. All the patients were discharged by one to three days of the procedure with improvement of their clinical condition. So PTCA and Stenting is a safe and effective technique with high procedural success rate and good short-term (hospital) clinical results in the native coronary artery lesions. Key words: Coronary artery diseases; PTCA and stenting. DOI: 10.3329/jbcps.v26i1.4230 J Bangladesh Coll Phys Surg 2008; 26: 26-31

Background :To accurately stratify patients undergoing PCI, according to their risk of future adverse events, a quest for risk predictors is ongoing worldwide. But only a few powerful and independent predictors of early and late major adverse cardiovascular events have been found. These include traditional risk factors, such as acute coronary instability, diabetes mellitus, reference vessel diameter, and lesion and/or stent length. This study was undertaken to find out the relationship between pre-procedural CRP level with in-hospital (both procedural and before discharge) complications. Materials & methods : This prospective study was carried out in National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period of June,2006 to May,2007. After fulfilling the exclusion criteria, 100 consecutive patients were selected as sample those underwent percutaneous coronary intervention. C-Reactive protein (CRP) was measured in all patients before the procedure. Those having pre-procedural CRP level

Since its introduction in 1977, Percutaneous Coronary Intervention (PCI) i.e. coronary angioplasty and/or stenting have gained increasing importance in the treatment of coronary artery disease. PCI has reduced the need for coronary artery bypass graft (CABG) surgery and are performed more and more frequently worldwide including Bangladesh. Though Dhaka Medical College Hospital (DMCH) is the pioneer institute for medical education in this country, the facilities for PCI and other cardiac intervention were previously not available in this institute. Recently, however, PCI has been introduced in DMCH. We are here reporting the first regular successful case of PCI done in DMCH. DOI: http://dx.doi.org/10.3329/jom.v13i1.10046 JOM 2012; 13(1): 43-45

Conventional treatment of left main coronary artery (LMCA) disease includes coronary artery bypass graft (CABG) and more recently, in selective indications, percutaneous coronary intervention (PCI). Direct surgical patch angioplasty of the LMCA using fresh autologous pericardium, saphenous vein, or mammary artery patch can be proposed as an alternative treatment. We have successfully operated one patient with surgical angioplasty for isolated ostial left main coronary stenosis at National Heart Journal. Keywords: LMCA; PCI; Surgical angioplasty DOI: 10.3329/cardio.v3i1.6439Cardiovasc. j. 2010; 3(1): 110-112

Objective To explore clinical effect of treating acute coronary syndrome (ACS) of renal transplant recipients with percutaneous coronary intervention and its safety. Methods Forty two renal transplant recipients who were diagnosed with acute coronary syndrome and received percutaneous coronary intervention (PCI) in our hospital were selected. Serum creatinine (Cr) and glomerular filtration rate (GFR) were compared before surgery, 48 ~ 72 hour after surgery and one year after surgery. All patients were followed up. Results All patients successfully completed PCI. Contrast-induced nephropathy was not found after surgery. Cr and GFR 48 ~ 72 hour after surgery and one year after surgery had no significant differences with that before surgery (P>0.05). The follow up lasted for (61.2±32.2) months averagely. Of 42 cases, 4 cases died, 6 cases were found with nonfatal myocardial infarction, 4 cases were observed with repeat revascularization and 12 cases had accumulative major adverse cardiovascular events (MACE). Conclusion PCI is proved to be effective in treating renal transplant recipients; no severe complications are found and renal function recovers well after treatment.

OBJECTIVES To identify the STEMI patients at high risk in terms of no-reflow during percutaneous coronary intervention (PCI) with a simple risk score system that can be used before reperfusion. METHODS Total 173 patients who had undergone primary or rescue percutaneous coronary intervention following the diagnosis of STEMI, were classified as "no-reflow" developers and "no-reflow" non-developers, during the procedure. The pre-procedural ECGs, laboratory parameters, demographic data, time for the treatment, and the treatment methods were evaluated with univariate analysis. The independent predictors were identified by multivariate logistic regression analysis among the no-reflow risk factors. Using the independent predictors, we developed a simple risk score system proportional to area under the ROC (AUROC) curves. RESULTS The independent predictors of "no-reflow" phenomenon were identified as follows: high values of blood glucose at reference; long symptom-onset-to-balloon-time; and low lymphocyte count. The incidence rates of "no-reflow" in patients with low (0-1), moderate (2-3) and high (4-6) risk factors were 13.3%, 40.0%, and 46.7%, respectively. The risk score system demonstrated a good risk prediction between patients with various risk levels of the development of "no-reflow" with a c-statistics of 0.734 (95% CI 0.654-0.814). CONCLUSION The development of "no-reflow" which is an adverse event in STEMI treatment can be predicted efficiently by simple clinical risk scoring method.

Objective: To evaluate the effects of ischemic postconditioning on expressions of pentraxin-related protein 3 (PTX3) and neutrophil CD11b in the plasma of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods: Fifty-six patients who had AMI with ST-segment elevation were randomly divided into a control group and an ischemic postconditioning group (n=28). Both groups received emergency PCI. After recanalization of infarct-related arteries, the control group did not receive intervention within three minutes, while the ischemic postconditioning group was treated by low-pressure filling and emptying of balloon within one minute. The plasma expressions of PTX3 before and 24 hour after PCI were detected by ELISA, and those of neutrophil CD11b were detected by flow cytometry. Results: PTX3 and neutrophil CD11b expressions of the two groups were similar before PCI, but those of the ischemic postconditioning group significantly decreased 24 hour after PCI (P

BACKGROUND AND OBJECTIVE: The association between smoking and clinical outcomes after coronary stenting is controversial. The aim of this meta-analysis was to assess the association between smoking and in stent restenosis (ISR), major adverse cardiac events (MACE), or major adverse cardiac and cerebrovascular events (MACCE) after coronary stenting. METHODS: A search for studies published before December 2014 was conducted in PubMed, Embase, and Cochrane library. An inverse random weighted meta-analysis was conducted using logarithm of the odds ratio (OR) and its standard error for each study. RESULTS: Ten studies investigated the association between smoking and ISR. Overall, smoking was not associated with ISR (OR: 1.05, 95% CI: 0.79-1.41; I(2) = 47.8%). Subgroup analysis also failed to show a significant association between smoking and ISR risk regardless of bare metal stent (BMS) and drug-eluting stent (DES) implantation. Eight studies explored the association between smoking and MACE, but no association was found (OR: 0.92, 95% CI: 0.77-1.10; I(2) = 25.5%), and subgroup analysis revealed that no distinct difference was found between BMS and DES implantation. Three studies investigated the association between smoking and MACCE and significant association was found (OR: 2.09, 95% CI: 1.43-3.06; I(2) = 21.6%). CONCLUSIONS: Our results suggest that in patients undergoing percutaneous coronary intervention with stent implantation, smoking is not associated with ISR and MACE; however, smoking is an independent risk factor for MACCE.

Clopidogrel is an analogue of ticlopidine, used for reduction of atherosclerotic events in patients with acute coronary syndrome (ACS), stroke, peripheral arterial disease and for elective percutaneous coronary intervention (PCI). It selectively and irreversibly blocks ADP binding to platelets. Its primary side effect is bleeding. However potentially fatal types of haematological dyscrasia such as aplastic anaemia, neutropenia, thrombocytopenia, pancytopenia may be associated with clopidogrel therapy. A 50 years old diabetic, hypertensive lady with angina was started to treat with clopidogrel along with other anti-ischaemic and anti-hypertensive drugs. Subsequently the patient developed leucopenia and thrombocytopenia after starting of clopidogrel. Five days later her complete blood count returned to normal after withdrawal of both anti platelets. Aspirin was re-introduced with great precaution. Later repeat leucocyte and platelet count were found to be normal. At follow- up 1 month after discharge patient found asymptomatic with normal blood count. To the best of our knowledge, clopidogrel induced haematological dyscrasia was not reported earlier in our country. Key words: Acute coronary syndrome; percutaneous coronary intervention. DOI: 10.3329/uhj.v5i2.4563 University Heart Journal Vol.5(2) July 2009 pp.89-90

Percutaneous Coronary Intervention (PCI) is associated with 5% to 30% incidence of elevation of serum Creatine Kinase MB fraction (CK-MB) reflect the periprocedural myonecrosis,’Appearance of Creatine Kinase MB (CKMB) in the circulation is the strongest predictor of long term clinical outcome of PCI 2-5 , correlating the deleterious consequences of myonecrosis on Left Ventricular function or Electrophysiological stability 6 . Pathophysiology of myonecrosis during PCI has been related to side branch closure or compression, major intimal dissection, intramural thrombus formation, coronary spasm, distal atheroembolization. The first four causes may be clinically apparent and measures can be taken during the procedure, the latter may be entirely asymptomatic and occur even Angiographically uneventful procedure. Contrast enhanced Magnetic Resonance Imaging suggest that distal embolization of atherogenic materials from plaque disruption 7 , causing micro infarction by obstructing the blood flow at capillary level 8,9 . Studies show that intra venous Adenosine infusion as an adjunct to reperfusion in the treatment of acute myocardial infarction associated with reduction of heart muscle damage 10,11 . Adenosine is a naturally occurring nucleoside with a half life in blood of less than 10 seconds. Adenosine may be administered via intravenous or Intracoronary route, produce hyperemic effect that is commonly used to measure the coronary flow reserve during PCI. The