ELECTIVE PERCUTANEOUS CORONARY INTERVENTIONS--A COMPARISION OF EFFICACY OF CLOPIDOGREL AND PRASUGREL.

BACKGROUND: Percutaneous coronary interventions are almost always preceded by the loading dose of platelets inhibiter drugs such as clopidogrel or prasugrel and followed by maintenance therapy to decrease the mortality and morbidity due to stent thrombosis. This study was conducted to compare the efficacy of clopidogrel and prasugrel for inhibiting platelet aggregation among patients undergoing elective percutaneous coronary intervention. METHODS: This randomized controlled trial study was done in Department of Cardiology, Postgraduate Medical Institute Govt. Lady Reading Hospital Peshawar. A total of 148 patients were randomly allocated to either group-A containing 74 patients using clopidogrel or group-B containing 74 patients using prasugrel RESULTS: Group-A had 55 (74.3%) male and 19 (25.7%) females while group-B had 56(75.7%) males and 18 (24.3%) females (p=0.85). Mean age was 54.9 +/- 11.2 years in group-A and was 57.7 +/- 8.7 years in group-B (p=0.09). Mean body weight was 71.8?6.4 Kg in group-A and 70.8 +/- 6.3 Kg in group-B (p=0.35). Mean Baseline platelet aggregation before drug administration was 10.43 +/- 1.9 ohm in group-A while 10.12 +/- 2.2 ohm in group-B (p=0.36). Mean Follow up platelet aggregation 6 hours after drug administration was 5.88 +/- 2.9 in group-A while it was 3.47 +/- 1.8 ohm in group-B (p=0.001). Mean Difference between basal and follow up platelet aggregation +/-SD was 52.9649 +/- 24.77 in group-A while it was 82.25 +/- 14.34 in group-B (p=0.001). 63(85.15%) of group-A had inhibition of platelets aggregation >10% as compare to 72(97.3%) of group-B had inhibition of platelets aggregation >10% (p=0.009). CONCLUSION: Prasugrel is more efficacious than clopidogrel in term of inhibition of platelets aggregation.

Radiation exposure in different cardiac catheterization procedures in cath lab.

BACKGROUND: Interventional procedures render cardiologolists and their team members to high doses of radiations. This study was conducted to assess the radiation exposure in various cardiac catheterization procedures. METHODS: This descriptive cross sectional study was conducted at the catheterization laboratory of Lady Reading Hospital Peshawar from November 2008 to December 2009. Patients were categorized into four groups for procedures a. coronary angiography, b. percutaneous coronary intervention (PCI), c. permanent pacemakers (PPM) and d. percutaneous transvenous mitral commisurotomy (PTMC), two groups for operators (consultants and trainees), and three groups for various accesses (femoral, radial and sub-clavian). RESULTS: A total of 99 patients undergoing cardiac catheterization were studied. Coronary angiography was performed in 52 (52.5%) patients, PCI in 32 (32.3%)), pacemakers in 6 (6.1%), and PTMC in 9 (9.1%) patients. Consultants did 72 (72.7%) procedures and trainees did 27 (27.3%) procedures. Through radial access, 22 (22.2%) procedures were performed, 71 (71.7%) through femoral, and 6 (6.1%) through sub-clavian. The mean radiation dose for coronary angiography was (4907.862 +/- 15231.6358 microGym2), PCI (10375.16 +/- 16083.4385 microGym2), pacemakers (1406.823 +/- 785.489 microGym2), and PTMC (1157.91 +/- 760.437 microGym2). The mean radiation dose for radial (6147.33 +/- 8480.37 microGym2), femoral (6512.58 +/- 16566.73 microGym2), and sub-clavian was (1406.82 +/- 785.48 microGym2). While for various operators consultants (7489.5 +/- 16925.55 microGym2), and trainees (2475.25 +/- 1178.86 microGym2). The mean time for radial (8.59 +/- 7.28 min), femoral (6.95 +/- 6.43 min) and sub-clavian was (8.24 +/- 4.81 min). The mean time for coronary angiography (4.56 +/- 5.32 min), PCI (11.44 +/- 6.92 min), PPM (8.24 +/- 4.81 min), and PTMC (8.28 +/- 5.01 min). CONCLUSIONS: Radiation dose varies substantially across different groups by different operators and different routes.

Outcome of balloon pulmonic valvuloplasty with 18 months follow up.

OBJECTIVE: To determine the immediate and intermediate term outcome of balloon pulmonic valvuloplasty by echocardiography. METHODS: This study was conducted in the Department of Cardiology Postgraduate Medical Institute Lady Reading Hospital (LRH), Peshawar from July 1999 to January 2003. Patients with severe pulmonic valve stenosis who underwent balloon pulmonic valvuloplasty during this period were included in the study. Forty Patients fulfilling the study inclusion criteria were followed up to 18 months by two dimensional and Doppler echocardiographic examinations at 6 months interval. Patients with dysplastic valve leaflets or for whom 18 months follow up data was not available were excluded from the study. Echocardiographic data was collected prospectively. Echocardiographic hemodynamic data was analysed initially and at all three follow up visits, using descriptive statistics and paired t-test. RESULTS: Total 64 balloon pulmonic valvuloplasty procedures were performed during this period. Forty patients fulfilled the study inclusion criteria and the remaining 24 patients were excluded from the study. Mean age of the patients was 13.05 +/- 8.22 years, ranging from 1-33 years. Pre-peak pulmonic valve gradient reduced from 100.9 +/- 29.20 mmHg to 31.38 +/- 15.99 mmHg (p < 0.0001) immediately after balloon pulmonic valvuloplasty. Pulmonic valve gradient at day 1 (31.38 +/- 15.99) reduced significantly at 18 months (18.88 +/- 10.24) (p < 0.0001). Complication encountered during the procedure was transient ventricular tachycardia or multiple premature ventricular contractions. CONCLUSION: Balloon pulmonic valvuloplasty is safe and effective in reducing pulmonic valve gradient acutely and the benefit persists till 18 months. Further fall in pulmonic valve gradient is seen in intermediate term follow up.