Efficacy and safety of transradial approach in primary PCI for STEMI

To determine the efficacy and safety of transradial approach in primary percutanous intervention in acute ST segment elevation myocardial infarction. Descriptive study Emergency reporting [ER] department of Armed Forces Institute of Cardiology National Institute of Heart Diseases [AFIC/NIHD] from Dec 2011 to Dec 2013 Retrospective data of 354 patients had been collected through records. All the patients presented with acute myocardial infarction to emergency reporting [ER] department of Armed Forces Institute of Cardiology National Institute of Heart Diseases were included in the study. All the patients underwent primary coronary intervention through transradial route. All patients received IIB IIIA inhibitors bolus and infusion. The primary end points were procedure success and local access site hematoma and secondary end points were major bleeding requiring blood transfusion and door to balloon time. The mean age of the patient was 64 +/- 18 years, there were 251 [70.9%] males and female were 103 [29.1%]. Radial access site cannulation time was 194 +/- 22 sec and door to balloon time was 78 +/- 14 min. Procedural success was 349 [98.6%]. Forearm hematoma was noted in 4 [1.12%]. No major bleeding requiring transfusion was noted. Primary percutanous intervention [PPCI] via transradial [TRI] route in acute STEMI patients can be achieved with high success and low complications in our population. The clinical outcome is matching with local and international data

Role of aspiration thrombectomy in primary PCI for STEMI - myth or reality?

The objective of the study was to determine the outcome of thrombus aspiration in Primary coronary intervention [PCI] for ST elevation myocardial infarction [STEMI]. Case Series The study was carried out in Armed Forces Institute of Cardiology - National Institute of Heart Diseases [AFIC-NIHD] over a period of twelve months from January 2013 to December 2013. Data of 30 patients who underwent aspiration thrombectomy during primary PCI for STEMI by the transradial approach was collected. Inclusion criteria were chest pain suggestive of myocardial ischemia lasting longer than 30 min accompanied by ST- segment elevation or new left bundle branch block on the ECG within 12 h of symptom onset. Patients with previous CABG, cardiogenic shock or requiring TPM placement were excluded from this study. A 6F sheath was placed inside the radial artery, and cardiac catheterization was performed. Angiographic and electrocardiographic signs of myocardial reperfusion were assessed. Study endpoints included TIMI III flow and ST-segment resolution at the end of the procedure. Mean age of the patients was 52 years [range 37-77 yrs] and 63% [n= 19] were males and 37% [n=11] were females. The right radial artery was used in 90% of cases. Thrombus aspiration catheter used was 6 F Thrombuster II [70%] and Hunter [30%].There was significant improvement in markers of myocardial reperfusion with achievement of ST-segment resolution and TIMI 3 flow in 28 patients [93%]. No case of vascular complications such as major access site bleeding, vascular perforation, radial artery occlusion, forearm ischemia, compartment syndrome or MACE was observed. Thrombus aspiration [TA] is applicable in the majority of patients undergoing primary PCI for myocardial infarction with ST-segment elevation, and it improves early markers of myocardial reperfusion

Successful implantation of percutaneous left ventricular assist device [impella 2.5] in AFIC/NIHD - first time in Pakistan

Impella 2.5 is a miniaturized percutaneously inserted left ventricular assist device [LVAD] that can be placed via a retrograde approach across the aortic valve using a femoral arterial access. It helps in reducing the cardiac workload and provides circulatory assistance and protection to the myocardium and vital organs in patients with severe left ventricular systolic dysfunction. It has been used in patients with heart failure, cardiogenic shock [CS], and high-risk patients undergoing percutaneous intervention [PCI].We report here our experience using an Impella 2.5 catheter in a patient with high-risk percutaneous intervention [PCI]