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Objective: To determine the in-hospital outcomes of primary percutaneous coronary intervention approach in a tertiary care cardiac center. Study Design: Retrospective observational descriptive study. Place and Duration of Study: Pakistan Naval Ship Shifa Hospital, Karachi Pakistan, from Jan 2018 to Dec 2019. Methodology: A total of 143 consecutive ST-elevation myocardial infarction patients presented to the ER within 24 hours of the onset of chest pain were included in this study. We included patients of both genders, aged >20 years and met the diagnostic criteria of ST-elevation myocardial infarction. Patients with cardiogenic shock, puncture site infection were excluded from the study. Results: Average age of patients was 54.2 ± 12.7 years (min-max age=24-92 years). Majority 130 (90.9%) of cases were males, while 55 (38.5%) patients had diabetes, 52 (36.4%) were hypertensive, 38 (26.6%) were smokers, family history of CAD was found in 10 (7%) cases and 8 (5.6%) cases had prior percutaneous coronary intervention or coronary artery bypass graft. Mostly 64.3% procedures were performed by trans-radial approach. Mean ± SD door-to-balloon time was 60.31 ± 29.8 minutes. About 72% patients received primary percutaneous coronary intervention within ≤60 min and 40 (28%) cases received primary percutaneous coronary intervention with door-to-balloon time >60 min. This study shown 100% success rate with zero mortality only one patient developed arrhythmia during procedure. Conclusion: Primary percutaneous coronary intervention through trans-radial approach was safe option with excellent success rates in terms of both morbidity & mortality rates. [ABSTRACT FROM AUTHOR]

Objective: To assess adequacy of anticoagulation in Warfarin treated patients with atrial fibrillation Study Design: Prospective observational study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, from Nov 2019 to Apr 2020. Methodology: All individuals fulfilling the inclusion criteria were enrolled in the study after their consent. Based upon their serial International Normalized Ratio (INR) values, Time in Therapeutic Range (TTR) was calculated using Rosendaal method. A TTR>70% was a marker of adequate anticoagulation. Factors associated with TTR <70% were identified. Results: Total 70 participants were included in the study. Mean age (± SD) was 51.43 (± 11.27) years. Thirty four (48.6%) were males and 36 (51.4%) were females. Twenty four (34.3%) had valvular atrial fibrillation while 46 (65.7%) had non-valvular atrial fibrillation. Overall, TTR>70% was observed in 29 (41.4%) of study participants. Poly-pharmacy and multiple co-morbidities were identified as statistically significant factors associated with subtherapeutic anticoagulation (TTR<70%). Conclusion: Determined TTR of study population indicates poor anticoagulation control in majority of patients being anticoagulated with Warfar in highlighting the need for focused interventions such as dedicated anticoagulation clinics and patient education. [ABSTRACT FROM AUTHOR]

Objective: To determine the relative efficacy of intravenous heparin as compared to intra-arterial heparin used during transradial coronary angiography for the prevention of radial artery occlusion. Study Design: Comparative cross-sectional study. Place and Duration of Study: Study was conducted at the Department of Cardiology, AFIC/NIHD Rawalpindi, Pakistan, from Jul 2019 to Dec 2019. Methodology: A total number of 144 patients were considered for the study using the consecutive sampling technique who were undergoing diagnostic coronary angiography. Patients were divided into the intra-arterial group (n=72) who received 50 IU/kg of unfractionated heparin (maximal dose 5,000 U) intra-arterially, and an intravenous group (n=72) received the similar dose through intravenous route. All patients were administered 100 mcg of nitroglycerin to minimize radial artery spasm. Coronary Angiography was performedusing a 6F introducer sheath and diagnostic catheters. Early radial artery occlusion (RAO) at 24 hours after the procedure was detected by performing the plethysmographic (reverse Barbeau's) and doppler USG evaluation. Chronic RAO was assessed 30 days after the procedure by performing the same tests. Data was collected through a predesigned proforma and analyzed using SPSS 23. A p-value of less than 0.05 was considered as significant. Results: Early RAO was found in 4 (5.6%) of the patients from the intra-arterial groupand 5 (6.9%) of the intravenous group. The difference was found to be statistically insignificant (p-value 0.731). Chronic RAO was observed in 3 (4.4%) of the intra-arterial group as compared to 4 (6%) of the intravenous group. This difference was also statistically insignificant (p-value 0.683) for chronic RAO. Conclusion: Intra-arterial and intravenous heparin administration providedsimilar efficacy to prevent RAO. [ABSTRACT FROM AUTHOR]

Objectives: To validate the application of ETT screening and to assess the extent of CAD in serving soldiers. Study Design: Comparative cross-sectional. Place and Duration of Study: Study was conducted in AFIC/NIHD, from Oct 2018 to Jun 2019. Methodology: Conducted in AFIC/NIHD for the duration of 9 months. Cases with abnormal ETT at screening were further worked up with Computed Tomographic (MSCT) Angiography. Those having critical disease underwent Coronary angiogram. All cases with severe or more disease, were worked for revascularization. Chi-square test was used to find association between ETT and its diagnostic yield and management modalities. A p-value <0.05 was taken as significant. Results: A total of 256 cases with abnormal ETT were studied with 57.8% (148) cases from age group of 35-45 years. Majority of the cases 203 (76.6%) had normal CT angiography and 26 (10.2%) cases had any pattern of critical disease and 9 (3.5%) cases had calcium. Out of 256 cases 36 (14.06%) were proceeded with further work up with coronary angiogram. 31 out of these 36 cases revealed any pattern of critical CAD with 19 (7.4%) proceeded to Percutaneous Coronary Intervention (PCI) and 14 (5.5%) were offered Coronary Artery Bypass Grafting (CABG). Results show statistically significant association between diagnostic techniques and treatment modality. Conclusion: The application of ETT screening for diagnosis of occult CAD is helpful. [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]

Objective: To determine the frequency of undiagnosed hypothyroidism in obese females. Study Design: Cross sectional. Place and Duration of Study: Department of General Medicine, Combined Military Hospital, Multan (a tertiary care hospital). Six months. Subjects and Methods: All individuals fulfilling the inclusion criteria were enrolled in the study after their consent. Based upon their height and weight, the body mass index was calculated and their blood drawn for thyroid profile. Results: Total 133 participants were included in the study and all were females, and their mean age (± SD) was 47.68 ± 11.382 years. The overall frequency of undiagnosed hypothyroidism was 4.5% (6 out of the 133 subjects) Conclusion: The determined frequency of undiagnosed hypothyroidism in obese females is not high enough to recommend mass screening in all obese females. [ABSTRACT FROM AUTHOR]