Role of 64-slice multi detector computed tomography for non-invasive visualisation of coronary artery bypass grafts for follow up in post CABG patients.

BACKGROUND: Coronary artery bypass graft surgery is a commonly performed revascularization procedure in ischemic heart disease patients. Conventional coronary angiography is an invasive method for evaluation of grafts in such patients. Non-invasive evaluation of grafts in post CABG patient has been made possible with the advent of 64-Slice Multi Detector Computed Tomography (MDCT) The Objective of the study was to non-invasively assess the graft patency with MDCT. METHODS: Sixty post CABG patients (52 male, 8 female) with atypical chest pain or stable angina were evaluated with MDCT for graft patency. The grafts were considered as patent if there was continuous lumen visualisation at origin, in the body and at its insertion with native recipient vessels. Grafts were defined as blocked when only stumps were seen. They were classified as stenotic if there was > or = 50% diameter narrowing. RESULTS: The mean age of the patients was 60.1 +/- 9.7 years, mean duration since CABG was 8.01 +/- 6 years. Total number of grafts assessed was 175 including 124 (71%) venous grafts and 51 (28.9%) arterial grafts. A total of 82/124 (66.1%) venous grafts and 47/51 (92%) arterial grafts were patent. Forty-two (34%) venous grafts were blocked whereas 4 arterial grafts were not developed. Arterial grafts patency was 92% and venous grafts patency was 67.7% after a mean follow up of 8.01 +/- 6 years. CONCLUSION: The study shows that 64 slice MDCT can be used for the evaluation of patency and occlusion of venous and arterial grafts in post CABG patients for follow up.

ST segment resolution post MI--a predictor of better outcomes.

OBJECTIVE: To compare, the post Myocardial Infarction in-patient outcome of patients with early ST resolution to those without ST resolution on ECG, in a South Asian population. METHODS: This was a prospective study done at the Punjab Institute of Cardiology, Lahore. Consecutive patients of ST elevation myocardial infarction, who were not treated with primary angioplasty but were thrombolysed were recruited at the time of arrival in the emergency department. Streptokinase was administered to all patients as the agent of thrombolysis. ECG was acquired at baseline and at 60 minutes post streptokinase administration. Patients were subsequently divided into two groups (A) Patients with ST segment resolution, after 60 minutes of administration of streptokinase (B). Patients without ST segment resolution, after 60 minutes of administration of streptokinase. This cohort was followed up through the in hospital stay for major complications which were recurrent ischaemic chest pain ,heart failure, arrhythmias and death, during the follow up period (Mean stay 3.01+/- 0.77 days). RESULTS: A total of 148 patients were included in this prospective study. There were 122 males and 26 females. In group A complications developed in 33 (35%) out of 95 patients and 43 (81%) out of 53 patients in group B (p< 0.001). Recurrent chest pain was present in 19 (20%) patients of group A and 31 (59%) patients of group B (p<0.001).Heart failure was the most common complication observed in both groups, 26 (27%) patients in group A and 33 (62%) patients in group B (p<0.001). Arrhythmias were more common in group B, with 17 (32%) patients from group B and 9 (10%) from group A developing this complication (p<0.001). CONCLUSIONS: The extent of ST segment resolution provides useful information about early clinical outcome in post-myocardial infarction patients.