Impact of anemia on in-hospital, one-month and one-year mortality in patients with acute coronary syndrome from the Middle East.

AIM: The aim of this study was to evaluate the impact of admission anemia on in-hospital, one-month, and one-year mortality in patients from the Middle East with acute coronary syndrome (ACS). METHODS: Data were analyzed from 7922 consecutive patients admitted to hospitals throughout six Middle-Eastern countries with the final diagnosis of ACS, as part of Gulf RACE II (Registry of Acute Coronary Events II). Anemia at admission was defined according to the World Health Organization definition (<13 g/dL in men and <12 g/dL in women). Analyses were conducted using univariate and multivariate statistical techniques. RESULTS: The median age of the cohort was 56 (48-65) years, with the majority being male (79%). Anemia at admission was present in 2241 patients (28%). Patients with anemia were more likely to have in-hospital complications including heart failure, recurrent ischemia, re-infarction, cardiogenic shock, stroke, and major bleed. Even after adjustment, anemia was still associated with mortality at in-hospital (odds ratio [OR]=1.71, 95% confidence interval [CI], 1.34-2.17; P<0.001), at one-month (OR=1.34, 95% CI, 1.06-1.71; P=0.016), and at one-year (OR=1.22, 95% CI, 1.01-1.49; P=0.049) post-admission with ACS. CONCLUSIONS: Admission anemia in patients with ACS from six Middle-Eastern countries was strongly associated with mortality at in-hospital, one-month, and at one-year. Hence, admission anemia must be considered in the initial risk assessment of ACS patients along with other risk scores.

Assessment of right ventricular diastolic function by tissue Doppler imaging in patients with acute right ventricular myocardial infarction.

BACKGROUND: It is known that right ventricular systolic parameters as assessed by color tissue Doppler imaging (TDI) are abnormal in patients with inferior wall ST elevation myocardial infarction (IWMI) with right ventricular myocardial infarction (RVMI). This study was undertaken to determine right ventricular diastolic function as assessed by TDI in patients with acute RVMI. METHODS: Thirty-five patients with first IWMI were studied and compared with 20 age-matched healthy controls, and categorized into those with (14 patients) and without (21 patients) RVMI based on standard ECG criteria. Peak systolic, peak early and late diastolic velocities (Sm, Em, and Am), Em/Am ratio along with time to Sm (ECG Q-Sm) and time to Em (ECG Q-Em) were acquired from the apical 4-chamber view at the lateral side of tricuspid annulus using TDI. RESULTS: Sm, Em, and Em/Am ratio was reduced significantly in patients with RVMI as compared with those without RVMI and healthy individuals (Sm [11.1 + or - 2.9] vs. [14 + or - 1.9] and [14.5 + or - 2.1] cm/sec, P < 0.01; Em [9.2 + or - 3.5] vs. [12.9 + or - 3] and [14.0 + or - 2.0] cm/sec, P < 0.01; Em/Am ratio 0.53 + or - 0.2 vs. 0.78 + or - 0.19 and 0.8 + or - 0.3 [P < 0.0001]). Among the intervals, there was significant prolongation of Q-Em (558 + or - 14.8 vs. 507 + or - 16.2 and 480 + or - 20 ms [P < 0.0001]) but Q-Sm and Am were not statistically different between the groups. CONCLUSION: Right ventricular TDI diastolic parameters are abnormal in patients with RVMI. The method of recording the velocities and time intervals are simple and can be used to assess right ventricular diastolic function in patients with RVMI. (Echocardiography 2010;27:539-543).

A large left atrial myxoma detected in emergency department using bedside transthoracic echocardiography.

We present a case of a 55-year-old woman with episodes of recurrent pulmonary edema that was diagnosed to have a large left atrial myxoma using bedside transthoracic echocardiography. This case illustrates the importance of a screening focused ultrasound examination of involved systems by emergency physicians in detecting causes for emergency clinical presentations.

A rare presentation of primary antiphospholipid syndrome.

This case presents a young patient with myocardial infarction, in-situ thrombosis of left anterior descending coronary artery and right common-iliac artery due to primary antiphospholipid syndrome. This report discusses the relationship between antiphospholipid antibodies and coronary artery disease along with management of this rare condition.

Primary antiphospholipid syndrome with recurrent coronary thrombosis, acute pulmonary thromboembolism and intracerebral hematoma.

We present a young patient with myocardial infarction who had recurrent coronary thrombosis, in-stent thrombosis, and a major pulmonary arterial thromboembolism due to primary antiphospholipid syndrome. He also developed multiple intracerebral hematomas following anticoagulation therapy and thrombolysis. We describe this rare case of primary antiphospholipid syndrome presenting with varied arterial abnormalities along with hemorrhage and highlight the need for caution while treating them with anticoagulants and thrombolytics.

Single right coronary artery continuing as left circumflex artery and hypoplastic left anterior descending artery: a rare coronary anomaly.

The occurrence of a single coronary artery (SCA) is rare in the absence of other associated anomalies of the heart and is often detected incidentally during coronary angiography. This anomaly is usually benign and various types of SCA have been described. We report a rare type of SCA originating from the right sinus of Valsalva, with the left circumflex artery (LCX) continuing from right coronary artery (RCA) and hypoplastic left anterior descending artery (LAD), which was incidentally found in a 63-year-old female presenting as unstable angina.

Immediate and Six-month Clinical Outcome of Percutaneous Coronary Intervention in a Tertiary Hospital in the Sultanate of Oman.

OBJECTIVES: To evaluate the clinical characteristics, angiographic profile, in-hospital and six-month clinical outcome of patients who underwent percutaneous coronary intervention in a tertiary hospital in the Sultanate of Oman. METHODS: Two hundred and five consecutive patients with both acute coronary syndrome and stable coronary artery disease, who underwent percutaneous coronary intervention between January 2007 and June 2007, were retrospectively analyzed. Follow-up information was obtained from outpatient visits of these patients at six-months. MAIN OUTCOME MEASURES: The primary end point in this study was the occurrence of major adverse cardiovascular events (MACE), defined as cardiac death, any myocardial infarction (MI), cerebrovascular accident (CVA) and target vessel revascularization (TVR) with either repeat percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Secondary end points included angiographic success rate, procedural success rate, angina status, and the rate of clinical and angiographic restenosis. RESULTS: The angiographic and procedural success rate was 98% and 95% respectively. Fifty-one percent of patients surveyed had single vessel disease, 34% had double vessel disease and triple vessel disease was seen in 15% of patients. Type A lesion was found in 16%, Type B in 55% and Type C in 29% of patients. The majority of patients had single vessel stenting (83%). The mean ± SD number of stents per patient was 1.6 ± 0.9.There were four in-hospital deaths (2%) and six patients (2.9%) had non-ST elevation myocardial infarction before hospital discharge. Out of 205 patients, 53 patients were lost to follow-up. Among the 148 patients followed up, 105 patients (71%) were asymptomatic at follow-up, 36 (24%) patients had stable angina and 7 (5%) had a late myocardial infarction including three patients with stent thrombosis (2%). Among the 43 patients with angina or late infarction, 28 patients underwent coronary angiogram. Angiographic in-stent restenosis was seen in 14 patients. Of them, 8 patients underwent CABG and 6 patients repeat PCI. Fourteen patients had patent stents.The remaining fifteen patients were on optimal medications including two patients with stent thrombosis as they refused coronary angiogram. Overall, 132 of 148 patients (105 asymptomatic/14 patent stents/13 with angina) (89%) were free from major adverse cardiac events. Considering anginal status and repeat angiograms, composite clinical (15 patients) and angiographic (14 patients) six-month restenosis rate in percutaneous coronary intervention patients (29/148) was 19.5%. CONCLUSION: Results of percutaneous coronary intervention in our setup is excellent with good immediate results, low complication rate, good six-month clinical outcome and is comparable to international standards.