Techniques to Treat Slow-Flow/No-Reflow During Primary Percutaneous Coronary Intervention.

OBJECTIVE: The aim of this study was to compare TIMI flow after administering intracoronary (IC) medications through various routes for the treatment of slow flow/no-reflow during primary PCI. METHODS: Two independent parallel cohorts of the patients who underwent primary PCI for STEMI and developed slow/no-reflow were recruited. Selection of cohort was based on the route of administration of IC medications as proximal or distal. Post administration TIMI follow was compared between the two cohorts. RESULTS: A total of 100 patients were included in both, proximal and distal, cohort. Distribution of angiographic, clinical and demographic characteristics was not significant between the two cohorts except prevalence of hypertension, and diabetes mellitus. Frequency of hypertension, and diabetes mellitus were 45 % vs.70 %; p < 0.001 and 28 % vs. 44 %; p = 0.018 among patients in distal and proximal cohort respectively. Final TIMI III flow was achieved in significantly higher number of patients in distal cohort with the frequency of 88 % vs. 76 %; p = 0.027 as compared to proximal cohort. CONCLUSION: Administration of IC medication via distal route is observed to be more effective for the treatment of slow flow/no-reflow during primary PCI. Distal route via export catheter or perforated balloon technique should be preferred wherever feasible.

Psychosocial Impact of COVID-19 on Healthcare Workers at a Tertiary Care Cardiac Center of Karachi Pakistan.

OBJECTIVES: Aim of this study was to determine the depression, stress, and anxiety level among healthcare workers working at a tertiary care cardiac center of Karachi Pakistan during COVID-19 pandemic. METHODS: This survey was conducted at the National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Participants of the study were fulltime employees of hospital. Data were collected using an online questionnaire and Depression, Anxiety and Stress - 21 (DASS-21) scale was used. RESULTS: A total of 224 healthcare workers were included, 46 (20.5%) participants were screened for moderate to severe depression, 20.1% (45) for moderate to severe anxiety, and 14.7% (33) for moderate to severe stress. CONCLUSION: A significant levels of depression, anxiety, and stress were noted with the major concerns of workplace exposure, increased risk of infection, and transmission to their families and friends.

Predictors of 6-month Mortality in Patients with Non-ST Elevation Acute Coronary Syndrome: A Study in Pakistani Population.

OBJECTIVES: For Southern Asian countries like Pakistan, there is inadequate evidence of risk factors associated with mortality in patients suffering from acute coronary syndrome (ACS), especially non-ST elevation ACS (NSTE-ACS) cases. Therefore, aim of this study was to evaluate predictors of 6-months mortality of patients presenting with NSTE-ACS. METHODS: For this prospective observational study we recruited adult patients diagnosed with NSTE-ACS at a tertiary cardiac center. All he patients were followed-up after six months and survival status was recorded. Logistic regression analysis was performed for six-month mortality and odds ratio (OR) and 95% confidence interval (CI) were reported. RESULTS: Six-month follow-up was successful for 280 patients. On univariate analysis age >65 years, increased heart rate, cardiac arrest at presentation, Killip class II-IV at presentation, and diabetes were found to be associated with increased risk of 6-months mortality with OR [95% CI] of 4.27 [1.9-9.58], 1.25 [1.1-1.41], 139.44 [16.9-1150.78], 68.45 [7.88-594.41], and 2.35 [1.06-5.22] respectively. On multivariable analysis Killip class II-IV at presentation, thrombolysis in myocardial infarction (TIMI) score of >4, and global registry of acute coronary events (GRACE) score ≥150 were found to be independent predictors of mortality after six months of NSTE-ACS with adjusted OR of 32.93 [2.65-408.8], 3.42 [1.35-8.66], and 8.43 [3.33-21.38] respectively. CONCLUSIONS: For patients with NSTE-ACS, our study showed seven clinical parameters to be associated with an increased risk of 6-month mortality. These included increasing age, increased heart rate, cardiac arrest at presentation, Killip class II-IV, diabetes, TIMI score of >4 and GRACE score of >150. Thereby aiding clinicians to apply strategic and precise interventions in monitoring these patients accordingly.

Prognostic value of GRACE score for in-hospital and 6 months outcomes after non-ST elevation acute coronary syndrome.

BACKGROUND: The aim of this study was to determine the predictive value of the Global Registry of Acute Coronary Events (GRACE) score for predicting in-hospital and 6 months mortality after non-ST elevation acute coronary syndrome (NSTE-ACS). RESULTS: In this observational study, 300 patients with NSTE-ACS of age more than 30 years were included; 16 patients died during the hospital stay (5.3%). Of 284 patients at 6 months assessment, 10 patients died (3.5%), 240 survived (84.5%), and 34 were lost to follow-up (12%) respectively. In high risk category, 10.5% of the patients died within hospital stay and 11.8% died within 6 months (p = 0.001 and p = 0.013). In univariate analysis, gender, diabetes mellitus, family history, smoking, and GRACE score were significantly associated with in-hospital mortality whereas age, obesity, dyslipidemia, and GRACE were significantly associated with 6 months mortality. After adjustment, diabetes mellitus, family history, and GRACE score remained significantly associated with in-hospital mortality (p ≤ 0.05) and age remained significantly associated with 6 months mortality. CONCLUSION: GRACE risk score has good predictive value for the prediction of in-hospital mortality and 6 months mortality among patients with NSTE-ACS.

Risk Factors Associated With Contrast-Induced Nephropathy after Primary Percutaneous Coronary Intervention.

Background Contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI) is associated with increased mortality and morbidity. The aim of this study is to determine the frequency of CIN after primary PCI and its association with risk factors in patients with ST-segment elevation myocardial infarction (STEMI) at a tertiary care cardiac center in Pakistan. Methodology In this observational study, we included 282 patients who presented with STEMI and underwent primary PCI at the National Institute of Cardiovascular Disease, Karachi, Pakistan, from October 2017 to April 2018. The serum creatinine (mg/dL) levels were obtained at baseline and 48 to 72 hours after the primary PCI procedure, and patients with a 25% increase or ≥ 0.5 mg/dL rise in post-procedure creatinine level (after 48 to 72 hour) were categorized for CIN. Results Out of a total sample of 282 patients, 68.4% (193) were males, and the mean age was 56.4 ± 9.1 years. A majority of the patients, 78.7% (222), were hypertensive and 34% (96) were diabetic. The CIN was observed in 13.1% (37) of the patients, and increased risk of CIN was found to be associated with the presence of diabetes mellitus and increased (>200 mL) use of contrast during the procedure, with odds ratios of 2.3 (1.14-4.63) and 3.12 (1.36-7.17), respectively. Conclusions The CIN after PCI is a common complication associated with the presence of diabetes mellitus and the use of an increased amount of contrast during the procedure.