Radial artery patency outcomes with saline flushing of the radial sheath after coronary intervention: A prospective cohort study.

OBJECTIVE: The implications of saline flushing of the radial sheath have not been studied in terms of radial artery occlusion. We aimed to investigate radial artery patency outcomes after the saline flush of the radial sheath. METHODS: In this prospective observational study, patients were selected to receive either radial sheath flushing with 10 mL of saline after pulling the sheath to one-third of its length (Group 1) or standard care (Group 2) after removal of the catheter sheath as per physician discretion. Radial artery patency was assessed by Doppler ultrasound at 24 h and 30 days after the procedure. RESULTS: A total of 2877 patients were enrolled in the study, with 1340 receiving radial sheath flushing and 1537 receiving standard care. At 24 h after the procedure, the incidence of radial artery occlusion was significantly lower in the radial sheath flushing group compared to the standard care group (4.4% vs 12.6%, p = 0.027). This difference persisted 30 days after the procedure (6.1% vs 15.8%, p = 0.015). Radial sheath flushing was independently associated with a lower risk of radial artery occlusion 30 days after the procedure, after adjusting for potential confounders (OR 0.375, 95% CI 0.18-0.77, p = 0.008). CONCLUSION: In conclusion, this prospective study provides evidence to support the use of radial sheath flushing after coronary intervention via the radial artery as a simple and effective strategy for reducing the risk of radial artery occlusion without increasing the risk of other adverse outcomes.

Incidence, predictors, and outcomes of DAPT non-compliance in planned vs. ad hoc PCI in chronic coronary syndrome.

OBJECTIVE: The disruption of dual antiplatelet therapy (DAPT) causes more adverse events after percutaneous coronary intervention (PCI). However, incidence and predictors of DAPT non-compliance are unknown in chronic coronary syndrome patients when compared between planned and ad hoc PCI. METHODS: This investigation was aimed to assess the incidence, predictors, outcomes, and primary mode of non-compliance of DAPT in patients with chronic coronary syndrome undergoing their first PCI. We analyzed the patients between planned (group 1) and ad hoc (group 2) PCI. RESULTS: There were a total of 628 participants in this investigation (370 were in planned PCI and 270 in the ad hoc PCI group). Out of 628 patients, by one month, 10% left DAPT in planned PCI group and 19.7% in ad hoc PCI group (aOR: 0.451, 95% CI: 0.285-0.713, p = 0.001). At 12 months, DAPT non-compliance was significantly more in ad hoc PCI group (52.7% vs. 47.8%; aOR: 0.647 95% CI: 0.470-0.891, p = 0.008). Age > 65 years (p < 0.001), low education status (p = 0.012), residents of rural areas (p < 0.001), ad hoc PCI group (p = 0.036), and angina class II (p = 0.038) were predictors for DAPT non-compliance in this cohort. CONCLUSION: Approximately 5 out of 10 patients disrupt DAPT due to non-compliance. This investigation provides an insight on additional predictors of non-compliance to DAPT, helping us to identify and address specific patient-related factors for disruption.

Optical Coherence Tomography Guidance In The Management Of Acute Coronary Syndrome Based On Plaque Morphology.

BACKGROUND: Acute coronary syndrome (ACS) is one of the leading causes of death worldwide. It is characterized by the formation of coronary artery thrombus which can be either due to plaque rupture, plaque erosion or rupture of a calcific nodule. The aim of study was to assess the plaque morphology leading acute coronary syndrome using OCT and to guide management based on its findings. It was an observational study, conducted at Rawalpindi Institute of Cardiology from Jan to Dec 2019. METHODS: Fifty patients meeting the inclusion criteria were included in the study. OCT procedure was performed following intracoronary injection of 100-150 ug of nitroglycerine. The imaging catheter (OFDI dragon view) of the OCT device (Terumo Luna wave OFDI, Tokyo, Japan) was inserted into the culprit artery. Blood clearance was achieved by injecting diluted iodinated contrast at the rate of 5 ml/sec. Imaging acquisition was obtained following automated pullback at the rate of 25 mm/sec. Pathologies like stent under deployment, mal-apposition, strut fracture, plaque erosion, plaque rupture were assessed by the operating interventionist well versed with the OCT technology and lesion assessment. Data analysis was done using the SPSS version 26. Categorical variables were presented as counts and percentages while continuous variables as mean±SD. RESULTS: A total of 50 patients were included in the study. The mean age was 49.24±11.92. Majority of the patients were male comprising 78.0% of the cases. Plaque rupture was the most common underlying pathology seen in 32.5% of the patients and exclusively in STEMI patients which required stent deployment. Thin cap fibroatheroma was seen in 27.9% of the cases while lipid rich plaque in 23.2% of the cases; again, requiring stent deployment. 9.3% of the cases had plaque erosion while 4.6% had calcific nodule and only 2.3% had intramural hematoma which were treated conservatively. 42.8% of the stent thrombosis patients had under-deployed stents requiring balloon dilatation while 14.2% had mal-apposed stent again requiring balloon dilatation. In contrast 14.2% each had neo-atherosclerosis, stent strut fracture and uncovered stent struts as the underlying pathology for stent thrombosis each requiring stent deployment. CONCLUSIONS: OCT guided PCI in cases of acute coronary syndrome is a valuable modality that gives insight into the underlying pathology of the disease process and also guides in proper management.

Subclinical Left Ventricular Dysfunction In Patients With Isolated Severe Rheumatic Mitral Stenosis Having Normal Left Ventricular Ejection Fraction.

BACKGROUND: Mitral stenosis (MS) is a prevalent disease in the developing world. It is a preventable disease associated with considerably high morbidity and mortality rates. Myocarditis secondary to rheumatic MS can cause left ventricular (LV) dysfunction. In majority of the case this LV dysfunction is subclinical. Recent development in imaging techniques like tissue Doppler imaging (TDI) and strain imaging enabled us to detect subclinical LV dysfunction. One such example is Global Longitudinal Strain (GLS), which is a reliable mean of assessing LV dysfunction in patients diagnosed with mitral stenosis. This study is design to determine the frequency of subclinical LV dysfunction in patients presenting with severe MS of rheumatic etiology in our institute. Objective of the study was to determine frequency of subclinical LV dysfunction by mean GLS in patients with isolated severe Rheumatic MS having normal LV Ejection fraction measured by 2D/M-mode echocardiography. It was an observational crosssectional study, conducted at Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, during the period of six months from 1st January to 30th June 2016. METHODS: Fiftyfive patients with isolated severe mitral stenosis of underlying rheumatic aetiology with preserve LV function (EF>50%) were selected as per other inclusion and exclusion criteria. All patients were evaluated with detailed history, physical examination and echocardiographic examination. GLS was also noted and all other information was recorded on data collection form. RESULTS: The average age and mean GLS was 48.20±11.62 years and -19.24±1.15% respectively. Left ventricular systolic impairment in patients under study using the Global Longitudinal Strain was seen in 16.36% (9/55) cases. CONCLUSIONS: Our results suggest that GLS helps in detecting impairment of LV systolic function at an early stage in patients with mitral stenosis which helps in their risk stratification thus warranting their early management.

Comparison of rhizosphere properties as affected by different Bt- and non-Bt-cotton (Gossypium hirsutum L.) genotypes and fertilization.

Incorporation of genetically modified crops in the cropping system raises the need for studying the effect of these crops on the soil ecosystem. The current study aimed to compare the effect of Bacillus thuringiensis (Bt)- and non-Bt-cotton (Gossypium hirsutum L.) genotypes on rhizosphere properties under fertilized and unfertilized soil conditions. One non-Bt-cotton (IUB 75) and four Bt-cotton varieties (IUB-222, MM-58, IUB-13, FH-142) were sown in a Randomized Complete Block Design (RCBD) in a factorial fashion with three replications under unfertilized (T1) and fertilized (T2 at NPK 310-170-110 kg ha-1) soil conditions. The culturable soil bacterial population was recorded at flowering, boll opening, and harvesting stages, while other rhizosphere biological and chemical properties were recorded at harvesting. Results revealed that Bt-cotton genotypes IUB-222 and FH-142 showed significantly higher rhizosphere total nitrogen, NH4+-N, available phosphorus, and available potassium. Total organic carbon and microbial biomass carbon was also maximum in the rhizosphere of IUB-222 under fertilized conditions. Similarly, bacterial population (CFU g-1) at flowering stage and at harvesting was significantly higher in the rhizosphere of IUB-222 as compared to non-Bt- (IUB-75) and other Bt-cotton genotypes under same growth conditions. It showed that Bt genotypes can help in maintaining soil macronutrients (total nitrogen, available phosphorus, and available potassium) under proper nutrient management. Moreover, Bt-cotton genotypes seem to strengthen certain biological properties of the soil, thus increasing the growth and yield capability, maintaining available nutrients in the soil as compared to non-Bt cotton, while no harmful effects of Bt cotton on soil properties was detected.