THE EFFICIENCY OF ANTI-COAGULANTS APPLIED DURING TRANSCUTANEOUS CORONARY INTERVENTIONS IN PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT ELEVATION OF ST SEGMENT

The purpose of study. To evaluate efficiency of different coagulants used under transcutaneous coronary interventions in patients with acute coronary syndrome without elevation of ST segment.The methods. The sampling of 346 patients was randomized in two groups. In the group I (n=155) transcutaneous coronary intervention was implemented using bivalirudin and in group II (n = 191) - using unfractionated heparin. The additional randomization of patients of group I: in subgroup A (n = 77) infusion of bivalirudin continued during four hours after intervention and in subgroup B (n = 78) infusion was discontinued in X-ray operating room. The criteria of inclusion: patients with acute coronary syndrome without elevation of ST segment with multi-vascular affection of coronary channel (risk on SYNTAX score = 23-32); high and medium degree of risk according GRACE scale; absence of re-vascularization of myocardium in anamnesis. The criteria of exclusion: patients with very high risk according GRACE scale; affection of left coronary artery trunk. The results. During period of hospitalization, total rate of intra- and post-operative cardiovascular complications had no reliable differences in two groups and amounted to 7.1% and 8.4% correspondingly (p = 0.6423). The serious bleedings (BARC 3 and 5) occurred reliably more frequently in patients of group II. Also, the groups had no differences in rate of development of acute thrombosis of stents. In subgroup A reliably less frequently occurred serious cardiovascular complications as compared with patients of subgroup B (1,3% и 13% correspondingly; р = 0,001). At that, rate of bleeding reliably had no differences. At trans-radial access, in patients of group I rate of bleeding and cardiovascular complications amounted to 0% and 2.9% and at trans-femoral access these indices were reliably higher - 3,3% и 10% correspondingly (р < 0,001). In group II a similar tendency is noted: at trans-radial access these indices amounted to 6% and 4.6% and at trans-femoral - 33.7% and 11.9% correspondingly (р

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Meta-Analysis of Radial Versus Femoral Access for Percutaneous Coronary Interventions in Non–ST-Segment Elevation Acute Coronary Syndrome

The American Journal of Cardiology ◽

10.1016/j.amjcard.2015.10.039 ◽

2016 ◽

Vol 117 (2) ◽

pp. 172-178 ◽

Cited By ~ 26

Author(s):

Chirag Bavishi ◽

Sadik R. Panwar ◽

George D. Dangas ◽

Nitin Barman ◽

Choudhury M. Hasan ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Meta Analysis ◽

Percutaneous Coronary Interventions ◽

Femoral Access ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Coronary Interventions ◽

St Segment ◽

Percutaneous Coronary ◽

Elevation Acute Coronary Syndrome

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Outcome of Patients Hospitalized with Acute Coronary Syndrome Fulfilling the Criteria of Metabolic Syndrome

Journal of Medicine ◽

10.3329/jom.v15i1.19857 ◽

2014 ◽

Vol 15 (1) ◽

pp. 31-35

Author(s):

Mohammed Shahadat Hossain ◽

Khan Abul Kalam Azad ◽

Prodip Kumar Biswas ◽

Md. Amir Hossain ◽

Jayanta Kumar Saha ◽

...

Keyword(s):

Diabetes Mellitus ◽

Metabolic Syndrome ◽

Acute Coronary Syndrome ◽

Heart Block ◽

Cardiovascular Complications ◽

Coronary Syndrome ◽

Group I ◽

Significant Difference ◽

Group Ii ◽

The Impact

The aim of the study was to assess the association of metabolic syndrome in patients with acute coronary syndrome and the impact of metabolic syndrome on clinical outcome. Total 210 ACS patients were included in this study and divided in group I & II on the basis of presence or absence of MS respectively. Among the study patients mean age in group I and group II was 52.99 ± 11.49 years and 53.34 ± 12.54 years respectively. Among the risk factors, hypertension (70%vs 15%), dyslipidemia (100 vs. 97%), diabetes mellitus (36.4% vs. 6%) were significant between two groups. Mean waist circumference recorded was 103.12 ± 4.15 in group I and 96.50 ± 6.43 in group II which was significant. Present study showed, in hospital outcome was worse in group I in comparison to group II and was significant, like cardiogenic shock (11% vs. 1%), LVF (28.2% vs. 16%), and CVD (5.45 vs. 0%). But there were no significant difference in heart block, tachyarrhythmia, cardiac arrest, reinfarction and death. Complications were far more in group I than in group II (14.5% vs. 52.0%) which was also highly significant. So, we conclude that the presence of MS in patients suffered from ACS was associated with a greater incidence of in-hospital cardiovascular complications and mortality.DOI: http://dx.doi.org/10.3329/jom.v15i1.19857 J Medicine 2014; 15: 31-35

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C-Reactive Protein in Patients with NSTEMI Acute Coronary Syndrome

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v1i1.8416 ◽

2013 ◽

Vol 1 (1) ◽

pp. 10-14 ◽

Cited By ~ 1

Author(s):

RK Dubey ◽

N Dhakal ◽

BKL Das ◽

NK Pandey ◽

N Baral ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Serum Levels ◽

C Reactive Protein ◽

St Segment Elevation ◽

Reactive Protein ◽

Coronary Syndrome ◽

Group I ◽

St Segment ◽

Group Ii ◽

Serum Crp

Background: C- reactive protein (CRP) is an acute phase inflammatory mediator that has been implicated as a risk factor for cardiovascular disease (CVD). The clinical presentation of acute coronary syndrome (ACS) ranges from unstable angina (UA) to non ST- segment elevation myocardial infarction (NSTEMI) and ST- segment elevation myocardial infarction (STEMI). Although, elevated levels of serum CRP have been reported in patients with CVD, the serum levels of CRP in patients with NSTEMI ACS is unknown. The purpose of the study was to determine whether the serum levels of CRP are higher in patients with NSTEMI ACS as compared to healthy controls. Methods: The study subjects consisted of two groups. Group I: (controls) twenty- five age-matched healthy men and Group II: Forty- five NSTEMI ACS patients. Fasting blood samples were collected and serum levels of CRP were measured by using highly sensitivity immunoassay rate method technology. Results: The serum levels of CRP in Group I and Group II were 3.2 ± 0.25 and 11.32 ± 2.1 mg/L, respectively and these values were significantly different from each other (p< 0.05). Group II showed a 253% higher level of CRP as compared to Group I subjects. Conclusion: The results demonstrate that the serum levels of CRP are higher in patients with NSTEMI ACS as compared to controls. Serum CRP levels are elevated in patients with NSTEMI ACS and may contribute to the inflammation and thrombosis associated with acute coronary syndrome. DOI: http://dx.doi.org/10.3126/jucms.v1i1.8416 Journal of Universal College of Medical Sciences Vol.1(1) 2013: 10-14

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Elevated Level of Plasma B-Type Natriuretic Peptide (BNP) as a Prognostic Marker in Patients with Acute Coronary Syndrome

Bangladesh Medical Journal ◽

10.3329/bmj.v46i2.40216 ◽

2019 ◽

Vol 46 (2) ◽

pp. 32-37

Author(s):

Dilshad Parvin ◽

Md Nasir Uddin ◽

Md Shahjahn Kabir ◽

Afsana Ahmed ◽

SM Rahat Hossain ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Logistic Regression ◽

Odds Ratio ◽

Binary Logistic Regression ◽

Prognostic Indicator ◽

Morbidity And Mortality ◽

Coronary Syndrome ◽

Group I ◽

Group Ii ◽

Age Range

Acute coronary syndrome (ACS), a life-threatening manifestation of coronary artery disease, ranges from unstable angina (UA) to acute myocardial infarction (AMI). To reduce the morbidity and mortality resulting from acute coronary syndrome, we should have to find out some predictor or prognostic indicator. A prognostic indicator should be available at the time of initial patient’s evaluation, in order to maximize the potential benefits of early risk assessment. This study designed to evaluate plasma BNP as a prognostic tool in patients with acute coronary syndrome. A prognostic cohort study was carried out with 90 (ninety) acute coronary syndrome patients on the basis of their clinical and laboratory criteria with age range of 30 to 90 years in the department of biochemistry, BSMMU, in collaboration with department of cardiology, NICVD, BSMMU and BIRDEM. Plasma BNP concentrations were measured on enrollment and then grouping of the study subjects were done on the basis of their empirical cut off value of plasma BNP concentration. All the patients were free from heart failure, renal disease, thyroid disease and hepatic disorder. Main outcomes were mortality, morbidity and survival after hospital discharge with or without any disability. All the subjects were categorized into two and to see the significance between two groups in relation to age and sex Unpaired –t test and Chi square test were done. Finally, Binary logistic regression was done. Among 90 acute coronary syndromes patients, there were 74(82.2%) male and 16(17.8%) female with mean age of the study population 51.8 years and the age range of 30 t0 90 years. Among enrolled patients, 24 (26.7%) were NSTEMI and 66 (73.3%) were STEMI that includes 29 (32.2%) anterior MI, 21 (23.3%) inferior MI, 16 (17.8%) other varieties of MI. All the study subjects were grouped into two on the basis of empirical cut off value of plasma BNP 640pg/ml on enrollment. Group I with plasma BNP level less than 640pg/ml includes 57 (63.3%) subjects and group II with plasma BNP more than 640pg/ml includes 33 (36.7%) subjects. Among group I (n=57) good recovery, morbidity and mortality found to be in 41(71.9%), 15(26.3%) and 1(1.8%) patients and those in group II (n=33) found in 6(18.2%), 19(57.6%) and 8(24.2%) patients respectively. Keeping the group I in reference category binary logistic regression analysis done, showing odds ratio 11.5 with p- value 0.000. The odds ratio 11.5 indicates that there is 11.5 times higher chance of getting bad outcome in ACS patients having higher plasma BNP concentrations. Bangladesh Med J. 2017 May; 46 (2): 32-37

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Value of ST- Segment Depression with T-Wave Inversion in Lateral Leads I, aVL, V4-V6 in Diagnosing the Left Main or Left Main Equivalent Coronary Artery Disease

Cardiovascular Journal ◽

10.3329/cardio.v9i2.32426 ◽

2017 ◽

Vol 9 (2) ◽

pp. 135-141

Author(s):

Sambhu Kumar Mallick ◽

Mahboob Ali ◽

Amal Kumar Chowdhury

Keyword(s):

Coronary Artery ◽

Predictive Value ◽

Left Main ◽

Stenotic Lesion ◽

Coronary Syndrome ◽

T Wave ◽

Wave Inversion ◽

Group I ◽

St Segment ◽

Group Ii

Background: Critical stenosis in the proximal part of the left anterior descending, severe 3 vessel disease and left main stem stenosis have all been recognized as clinical conditions complicated by a high incidence of large infarction, pump failure, arrhythmias and sudden death in patients with acute coronary syndrome (ACS). As many effective treatment modes are available currently, early recognition of those circumstances is crucial for appropriate management.Methods: this observational study was carried out at the Department of Cardiology, National Institute of Cardiovascular Disease (NICVD), Dhaka. Patients (30 patients) with NSTEACS having ST-segment depression with T-wave inversion maximally in leads I,avL,V4-V6 were considered as cases (Group I) and those (30 patients) with ST-segment depression without T-wave inversion in lateral leads were controls (Group II). Coronary angiogram (CAG) was done during in-hospital stay.Results: In present study, it was evident that among group I patients, 43.3% had stenotic lesion in left main artery (LM) and 26.67% in LM equivalent coronary artery (LME CA), whereas had no stenotic lesion in LM and 3.33% had LME CA lesion in group II patients. Low cost, widely available ECG criteria is supposed to be useful predictor of left main or left main equivalent coronary artery obstruction (Sensitivity=95%, Specificity= 76%, Positive predictive value= 70.0% and Negative predictive value= 97.0%) and high STsegment changes score (>18 mm (100%) &/or ³10mm (80%) was an additive predictor of LM or LMECA lesion.Conclusion: Maximum ST- segment depression with T-wave inversion in the lateral leads I, aVL, V4-V6 on admission ECG can predict the critical LM or LMECA obstruction in patients with NSTEACS. It can help to provide prompt and appropriate management earlier to reduce the mortality & morbidity.Cardiovasc. j. 2017; 9(2): 135-141

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Study of Lipid Profile and Coronary Angiographic Pattern in Young Bangladeshi Patients with Acute Coronary Syndrome

Cardiovascular Journal ◽

10.3329/cardio.v1i2.8237 ◽

1970 ◽

Vol 1 (2) ◽

pp. 183-188 ◽

Cited By ~ 1

Author(s):

AR Khan ◽

AAS Majumder

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Lipid Profile ◽

Older Age ◽

Age Group ◽

Coronary Angiogram ◽

Coronary Syndrome ◽

Group I ◽

Younger Age ◽

Group Ii

Background: Majority of the patients of coronary heart disease (CHD) in our country are above 40 years of age but a good number of patients belong to the age under 40, the most valuable and productive period of life during which they can devote themselves to uplift their family, society and country and can participate in nation building activities.3,4 The number of young individuals falling into the spectrum of CHD is increasing everywhere However, this age trend is peculiar in relation to the western age incidence.5 Our objective was to investigate the lipid profile and coronary angiographic pattern in young Bangladeshi patients with acute coronary syndrome and also to find out the relationship between dyslipidemia and coronary artery disease in this age group. Methods: This observational study was carried out in National Institute of Cardiovascular Diseases (NICVD) during the period of January 2000 to December 2000. A brief history was recorded on the date of admission and fasting lipid profile was done within 24 hours of admission. Other associated major risk factors were looked for and recorded accordingly. After stabilization oh the acute condition patient was prepared for coronary angiogram and informed consent was taken. Accordingly elective CAG was done. Among them total 64 patients of ACS, underwent coronary angiogram in the cath lab of NICVD, were selected randomly of which of which 32 patients were up to the age 40 years (Group- I) and 32 were above 40 years of age (Group-II). Patient of ACS of either sex having no age limitation were included without prior history of Percutaneous Coronary Intervention or Coronary Artery Bypass Graft surgery. The findings were reviewed and scrutinized carefully by two interventional cardiologists. In doubtful cases third expert reviewed the CD. If a consensus was not reached due to technical or visual error, the case wais discarded from the study. Details of CAG findings i.e. site and number of diseased vessels, location, morphology and pattern of lesion were studied and recorded accordingly. Results: The prevalence of dyslipidaemia and positive family history were more in group I than group II. Younger age group has less favorable lipid profile than older age group having raised total cholesterol in 31.3 percent cases, low HDL in 12.5 percent cases and raised LDL in 31.3 percent cases, while in older age group, it was 21.8, 25.0, 0 and 18.7 percent, respectively. CAG study of the patients showed that no vessel involvement was more common in group I than group II (21.9% vs 12.5%), but triple vessel disease was more common in group II (12.5% vs 21.8%). Single vessel and double vessel diseases were similar in both the groups. Involvement of LAD was slightly more in-group I than group II (68.8% vs 65.6%) and involvement of LCX and RCA were less in group I than group II (21.9% vs 34.3%, and 43.8% vs 78.1%, respectively). Diffuse LAD and RCA lesions were more in group II (36.4% vs 52.4% and 42.9% vs 48.0%, respectively), but diffuse LCX lesion was more in group I (42.9 vs 36.4%). Multiple irregular lesions are more common in older age group (53.1%) than younger age group (28.1%). Conclusion: The younger age group has less favorable lipid profile than older age group having raised total cholesterol, decreased HDL and raised LDL. CAG findings show that most of the lesions are present in LAD (having less impressive LVEF) as like as in older age group, but older age group has more multiple irregular lesions. Prevalence of >2 lesions in one coronary artery was more in group I (31 vs. 25%) but difference was not statistically significant. Keywords: Lipid profile, Coronary angiogram, Younger patients, Acute Coronary Syndrome. DOI: http://dx.doi.org/10.3329/cardio.v1i2.8237 Cardiovasc. j. 2009; 1(2): 183-188

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