scholarly journals The Severity and Extent of Coronary Artery Disease in Khat User Yemeni Patients

Author(s):  
Al-Zendani A. S. MD ◽  
Al-Dobhani B. A., MD. ◽  
Al-Garmozi H. M., MD ◽  
Ali Ahmed Al-Zaazaai, M.Sc.

Background: Khat is the leaves of the Catha Edulis plant, contains cathinone, ephedrine, epinephrine, and other substances. Khat chewing is one of the major social habits in Yemen and some studies reported that the khat chewing is associated with worse outcome in patients with acute coronary syndrome compared with non-khat users but there are limited data about the effect of khat and the severity of coronary artery disease. Objectives: This study was performed to determine the extent and severity of coronary artery disease in khat chewer patients in Yemen. Patients and Method: Patients who underwent coronary angiography as a planned procedure at the cardiac center of Al-Thawra Modern General Hospital over six months duration were included in this cross-sectional prospective study. A well-designed questionnaire was filled which including complete personal and clinical history for each patient, the presence of CHD risk factors, echocardiography, and coronary angiography findings. The data after that were analyzed using the SPSS program and different correlations were statistically established among variables. Results: The total number of patients admitted with a diagnosis of ischemic heart disease and planned for coronary angiography were 365 patients in which khat chewer patients group were 306 (84%) compared with 59 (16%) of non-khat chewers. The mean ages were (55+ -10 vs. 57+ -9, P=0.396). History of smoking was (83% vs. 17%, P<0.001) in khat chewers and non-khat chewers respectively. The prevalence of DM & HTN were (44% vs. 36%, P=0.243) & (30% VS. 39%, P=0.I194) in comparing both groups respectively. The history of the acute coronary syndrome was more prevalent among the khat chewer patients group (54% vs. 24%, P<0.001). Impaired LV systolic function was more prevalent among khat chewer patients group associated with a significant statistical difference & EF<50% was(39% vs. 23%, P=0.024) in both groups respectively. The significant coronary stenosis was more frequent in the khat chewer patients group (66% vs. 45%, P=0.O42). The khat chewer patients group also had more atherosclerotic coronary arteries (64% vs. 50%, P=0.056), more prevalence of multi-vessel disease (27% vs. 22%, P=0.090), and more frequent of type C coronary artery lesions complexity (20% vs. 12%, P=0.011). On the other hand, the history of recurrent stable angina was more prevalent among the non-khat chewer patients group (76% vs. 45%, P<0.001) & the normal coronary arteries were more frequent among the non-khat chewer patients group (46% vs. 29%, P<0.001). Conclusion: Khat chewer patients had more atherosclerotic coronary arteries, more lesion complexity, a severe form of coronary artery disease, and more prevalence of the multi-vessel disease. Finally, we concluded that khat chewing is one of the risk factors of coronary artery disease in Yemen.

Author(s):  
Vikas A. Mishra ◽  
Amit B. Kinare ◽  
Jayanta Pal ◽  
Vishwa Deepak Tripathi ◽  
Ravi Shankar Sharma ◽  
...  

Background: Coronary heart disease is the most common indication among cardiovascular diseases (CVD) and a major cause of mortality and morbidity. According to global burden of disease study estimates, nearly 24.8% of all deaths in India are attributable to CVD. Objectives of the current research study were to establish a correlation between varied risk factors and coronary artery disease (CAD), to determine angiographic characteristics individually in patients with multiple risk factors and to evaluate number of vessels involved in CAD.Methods: Present study was a prospective study conducted on 50 patients with acute coronary syndrome below 40 yrs of age admitted at the department of cardiology, Superspeciality hospital, NSCB medical college, Jabalpur. All patients included in the study were subjected to coronary angiography. The angiographic characteristics such as extent of CAD (characterized by the number of vessels with angiographic lesions) were determined.Results: Current study findings depicted that most of CAD patients were in age group of 36-40 years. Proportion of males was higher than females. One-fifth of patients were diabetics and 34.0% were hypertensive. It was observed that 54.0% CAD patients had history of smoking and 32.0% had history of premature CAD. Most of patients exhibited single vessel disease in CAG and left anterior descending (LAD) was the most commonly involved artery.Conclusions: Smoking was concluded as one of the major risk factor associated with CAD and most of patients exhibited single vessel disease, LAD being the most commonly involved artery. Significant number of patients with family history depicted high risk for CAD. Males were concluded to be more prone to CAD at younger age.


2019 ◽  
Vol 6 (2) ◽  
pp. 232
Author(s):  
Neelakandan Ramya ◽  
V. Prabakaran ◽  
Ahmed Abbas ◽  
Sethu Prabhu Shankar

Background: Coronary artery disease has become a global health problem affecting a significant portion of population in developed as well as the developing countries. The objective of the present endeavor is to study the pattern of coronary artery involvement by coronary angiography in patients with angina and to correlate the risk factors with the pattern of coronary artery involvement.Methods: This study was done as a cross sectional study on 50 patients with angina, attending the department of Medicine and Cardiology in Aarupadai veedu medical college hospital, Pondicherry from January 2018 to March 2018, who later underwent coronary angiogram. All patients of both sexes aged above 18 years presenting with history of angina both stable and unstable were included in the study, while those with previous history of congestive cardiac failure, malignant diseases, chronic kidney disease, autoimmune disorders were excluded from the study. Study was carried out in all patients fulfilling the inclusion and exclusion criteria. Data with regards to age, sex, diabetes, dyslipidemia were collected and analysed by appropriate statistical methods.Results: A total of 50 patients with 30 males and 20 females presented with anginal chest pain, of the total 50 patients, 19 were smokers, 9 had family history of coronary artery disease, 31 patients had hypertension, 14 had diabetes and 39 of the study population had dyslipidemia. Coronary angiography showed 48% of the study population had a single vessel disease and 32% with double vessel disease. Left anterior descending artery (LAD) was predominantly involved with 25 (50%) of total cases. Single vessel disease was common among those with hypertension and dyslipidemia.Conclusions: Coronary artery disease (CAD) is common in young adults. Dyslipidemia, hypertension and smoking are the most important risk factors associated with CAD. Left anterior descending artery is commonly involved in CAD followed by right coronary artery.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Balcer ◽  
I Dykun ◽  
S Hendricks ◽  
F Al-Rashid ◽  
M Totzeck ◽  
...  

Abstract Background Anemia is a frequent comorbidity in patients with coronary artery disease (CAD). Besides a complemental effect on myocardial oxygen undersupply of CAD and anemia, available data suggests that it may independently impact the prognosis in CAD patients. We aimed to determine the association of anemia with long-term survival in a longitudinal registry of patients undergoing conventional coronary angiography. Methods The present analysis is based on the ECAD registry of patients undergoing conventional coronary angiography at the Department of Cardiology and Vascular Medicine at the University Clinic Essen between 2004 and 2019. For this analysis, we excluded all patients with missing hemoglobin levels at baseline admission or missing follow-up information. Anemia was defined as a hemoglobin level of &lt;13.0g/dl for male and &lt;12.0g/dl for female patients according to the world health organization's definition. Cox regression analysis was used to determine the association of anemia with morality, stratifying by clinical presentation of patients. Hazard ratio and 95% confidence interval are depicted for presence vs. absence of anemia. Results Overall, data from 28,917 patient admissions (mean age: 65.3±13.2 years, 69% male) were included in our analysis (22,570 patients without and 6,347 patients with anemia). Prevalence of anemia increased by age group (age &lt;50 years: 16.0%, age ≥80 years: 27.7%). During a mean follow-up of 3.2±3.4 years, 4,792 deaths of any cause occurred (16.6%). In patients with anemia, mortality was relevantly higher as compared to patients without anemia (13.4% vs. 28.0% for patients without and with anemia, respectively, p&lt;0.0001, figure 1). In univariate regression analysis, anemia was associated with 2.4-fold increased mortality risk (2.27–2.55, p&lt;0.0001). Effect sizes remained stable upon adjustment for traditional risk factors (2.38 [2.18–2.61], p&lt;0.0001). Mortality risk accountable to anemia was significantly higher for patients receiving coronary interventions (2.62 [2.35–2.92], p&lt;0.0001) as compared to purely diagnostic coronary angiography examinations (2.31 [2.15–2.47], p&lt;0.0001). Likewise, survival probability was slightly worse for patients with anemia in acute coronary syndrome (2.70 [2.29–3.12], p&lt;0.0001) compared to chronic coronary syndrome (2.60 [2.17–3.12], p&lt;0.0001). Interestingly, within the ACS entity, association of anemia with mortality was relevantly lower in STEMI patients (1.64 [1.10–2.44], p=0.014) as compared to NSTEMI and IAP (NSTEMI: 2.68 [2.09–3.44], p&lt;0.0001; IAP: 2.67 [2.06–3.47], p&lt;0.0001). Conclusion In this large registry of patients undergoing conventional coronary angiography, anemia was a frequent comorbidity. Anemia relevantly influences log-term survival, especially in patients receiving percutaneous coronary interventions. Our results confirm the important role of anemia for prognosis in patients with coronary artery disease, demonstrating the need for specific treatment options. Figure 1. Kaplan Meier analysis Funding Acknowledgement Type of funding source: None


Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 4-5
Author(s):  
Moataz Ellithi ◽  
Fouad Khalil ◽  
Smitha N Gowda ◽  
Waqas Ullah ◽  
Radowan Elnair ◽  
...  

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening clinical syndrome characterized by microangiopathy and a variable degree of end-organ ischemic damage. Cardiac involvement has been recognized as a major cause of mortality in these patients (Patschan et al, Nephrol Dial Transplant, 2006; Benhamou et al, J Thromb. Haemost, 2015). In this study, we aim to investigate clinical predictors and outcomes of acute coronary syndrome in the setting of TTP admissions. Methods: The National Inpatient Sample (NIS) was queried for all hospitalizations with a primary diagnosis of thrombotic microangiopathy (ICD- 9-CM code 4466 and ICD-10-CM code M3.11) from 2002 to 2017. Using ICD-9-CM procedure codes (9972), (9971), and (9979), as well as ICD-10-CM procedure codes (6A551Z3) and (6A550Z3) we identified patients who received plasma exchange (PLEX) during the same admission. Due to the wide spectrum of thrombotic microangiopathy diseases, we decided to include only those who received PLEX to get a more specific subpopulation who were presumed to have TTP. We stratified patients based on whether or not they had acute coronary syndrome (ACS) during the admission, defined as presence of any ICD code for either ST-segment elevation myocardial infarction (STEMI), Non-STEMI, or unstable angina. Baseline characteristics and inpatient outcomes were compared between groups. Statistical analysis was performed using SPSS v26 (IBM Corp, Armonk, NY, USA). The odds ratio (OR) and 95% confidence interval (CI) were calculated using the Cochran-Mantel-Haenszel test. A multivariate regression model was deployed to assess predictors of inpatient mortality. Complex weights were used throughout all calculations, enabling appropriate national projections. Results: A total of 15,640 patients with the diagnosis of thrombotic microangiopathy were identified during the studied period. Of those, 6,214 patients had received PLEX treatment during their admission (39.7%). The annual admission rate for TTP was ranging between 5-7/100,000 admissions. Patients had a mean age of 47.8 years; 67% were females, and 46.5% were Caucasian. Stratifying by geographic region, 24% were from the Northeast, 21% from the Midwest, 42% from the South, and 13% from the West. The most common primary payer was private insurance (42.7%). Overall inpatient mortality was 9.1%. The most common complications reported included acute kidney injury (42.5%), followed by acute respiratory failure (14.9%), incident dialysis (14.3%), acute encephalopathy (7.7%), acute heart failure (7.3%), acute cerebrovascular accident (7.2%), and acute coronary syndrome (6.3%). ACS was documented in 6.7% of patients. Compared with patients without ACS, those with ACS were relatively older and had a relatively higher prevalence of coronary artery disease, dyslipidemia, diabetes mellitus, essential hypertension, chronic kidney disease, and heart failure. Patients with ACS had a 3-fold higher in-hospital mortality and a longer mean hospital stay (19 days vs. 15 days, P&lt;0.001). Using stepwise logistic regression, we identified age (aOR 1.03; 95% CI, 1.02 - 1.03; P &lt;0.001), history of heart failure (aOR 2.02; 95% CI, 1.53-2.67; P &lt;0.001), and history of coronary artery disease (aOR 2.69; 95% CI, 2.03 - 3.57; P &lt;0.001) as independent predictors of ACS among patients hospitalized with TTP. On another regression analysis, certain complications were more prevalent in the ACS group including acute cerebrovascular accidents, acute heart failure, acute kidney injury, cardiogenic shock, and respiratory failure. Conclusion: Despite wider utilization of therapeutic plasmapheresis and improved supportive treatments for patients with TTP, associated morbidity and mortality remain significant. We demonstrate from this large retrospective cohort that ACS is an independent predictor of higher morbidity and mortality in TTP patients. We identified older age, history of heart failure, and history of coronary artery disease as independent predictors of ACS among patients admitted with TTP. Further studies are warranted to develop risk stratification models for patients with TTP. Figure Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.: Honoraria, Research Funding, Speakers Bureau.


2020 ◽  
Vol 41 (34) ◽  
pp. 3255-3268 ◽  
Author(s):  
L Christian Napp ◽  
Victoria L Cammann ◽  
Milosz Jaguszewski ◽  
Konrad A Szawan ◽  
Manfred Wischnewsky ◽  
...  

Abstract Aims Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS. Methods and results Coronary anatomy and CAD were studied in patients diagnosed with TTS. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 TTS patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non-obstructive CAD, and 35.7% had angiographically normal coronary arteries. A total of 47 patients (4.6%) underwent percutaneous coronary intervention, and 3 patients had acute and 8 had chronic coronary artery occlusion concomitant with TTS, respectively. The presence of CAD was associated with increased incidence of shock, ventilation, and death from any cause. After adjusting for confounders, the presence of obstructive CAD was associated with mortality at 30 days. Takotsubo syndrome patients with obstructive CAD were at comparable risk for shock and death and nearly at twice the risk for ventilation compared to an age- and sex-matched ACS cohort. Conclusions Coronary artery disease frequently coexists in TTS patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome. Trial registration ClinicalTrials.gov number: NCT01947621.


2015 ◽  
Vol 10 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Tanjima Parvin ◽  
KMHS Sirajul Haque ◽  
Md Abu Siddique ◽  
SM Ahsan Habib ◽  
Mukhlesur Rahman ◽  
...  

Objective: Diabetes mellitus, a common metabolic disorder, is often associated with severe coronary artery disease. In this study, we compared the angiographic severity of coronary artery disease in diabetic patients compared with that of non diabetic patients.Methods: This observational study comprised of 102 subjects who had coronary artery disease on coronary angiography in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2009 to December 2009. The patients were divided into two groups: one group with 24 (23.5%) diabetic patients and another group with 78 (76.5%) non diabetic patients. Demographic, clinical, laboratory and angiographic data were analyzed and compared between two groups.Results: Mean age±SD of the study subjects was 52.8±9.5 years and 94 (92%) of them were male. Diabetic patients were older (mean age±SD; 57.6±9.5 versus 51.3±9.9 years; p 004), and had higher frequency of hypertension (75% versus 50%, p 0.036), chronic stable angina (71% versus 41%, p 0.018), and lower frequency of smoking (42% versus 67%, p 0.034) and acute coronary syndrome (29% versus 59%; p 0.018) in comparison to non diabetic patients. Left main stem disease (21% versus 5%, p 0.031) and three-vessel disease (50% versus 31%, p 0.094) were more prevalent in diabetic patients. Severe coronary artery stenosis was significantly more present in diabetics than non diabetics (Gensini score, 50.9±29.9 versus 32.6±21.9, p 0.001).Conclusion: Diabetic patients are more likely to have severe and extensive coronary artery disease. Left main stem and triple vessel disease are more commonly seen in diabetic patients compared to non diabetic patients.University Heart Journal Vol. 10, No. 1, January 2014; 13-17


2017 ◽  
Vol 14 (1) ◽  
pp. 17-20 ◽  
Author(s):  
Amit Shrestha ◽  
Sanjeev Thapa ◽  
Sheelendra Shakya ◽  
Ravi Shahi ◽  
Chandra Mani Paudel ◽  
...  

Background and Aims: The use of coronary angiography in diagnosing coronary artery disease is limited by its invasive property. In the other hand correct interpretation of tread mill test data and its use as a key diagnostic modality also has been a problem. The study was thus aimed to see the diagnostic accuracy of treadmill test to rule out coronary artery disease.Methods: We included all the patients who had positive tread mill stress test and underwent coronary angiography and were subsequently analyzed for presence of coronary artery disease.Results: A total of 303 patients were included with 119 males and 184 females with mean age of 53.6±10.5 yrs and 51.7±8.6 yrs respectively. Normal coronaries was seen in 114(54.0%), borderline lesion in 29 (13.7%) and significant lesion in 68 (32.2%) with 48(22.7%) having single vessel disease, 29(13.7%) double vessel disease and 14(6.6%) triple vessel disease. Coronary artery diseases was highest among diabetics (57.7%, OR 1.72 (95 % CI: 0.92 to 3.20), p value-0.08).Similarly the risk of coronary artery disease was significantly highest among patient with ≥2 risk factor (OR: 8.10,95 % CI: 4.96 to 13.24, P < 0.0001). Gender distribution showed that coronary artery disease was significantly higher in males than females (53% vs 35% respectively, OR: 2.08, 95 % CI: 1.30 to 3.32, p value-0.002).Conclusion: The value of tread mill test to predict coronary artery disease is highest in patients with two or more risk factor especially in those with diabetes with significance increased among males.


2018 ◽  
Vol 33 (2) ◽  
pp. 80-84
Author(s):  
Syed Dawood Md Taimur ◽  
Sahela Nasrin ◽  
M Maksumul Haq ◽  
MA Rashid ◽  
Hemanta I Gomes ◽  
...  

Background : Diabetes mellitus is one of the important risk factors for coronary artery disease. The hemoglobin A1c is used for evaluating glycemic control in diabetic patients. Here, we conducted the study to evaluate the relationship between HbA1c level and severity of coronary artery disease among the hospitalized patients with ACS. Materials & Methods : This cross sectional study was conducted in the department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from September 2015 to December 2015. Total of one hundred patients were studied and they were grouped on the basis of their glycaemic status. One hundred patients with acute coronary syndrome were enrolled in this study. Out of them fifty were diabetic (HbA1c>6.5%) and rest of were nondiabetics (HbA1c<6.5%) ( group-A and B). Results: Out of one hundred patients fifty eight were male and fourty two were female. Mean age of patients in group-A was 58.54±10.22 years and mean age of patients in group-B was 54.52±13.69 years. Mean age of male and female was 57.72±11.48 years and 54.0±13.08 years respectively. Mean HbA1c of patients in group-A was 11.43±1.43% and group-B was 6.34±0.915%. 38% of group-A and 22% of group-B had triple vessel disease, 26% of group-A and 20% of group- B had double vessel disease and 28% of group-A and 18% of group-B had single vessel disease, and 8% of group-A and 40% of group-B had normal coronary arteries. 48% patients of age group 46-50 in group-A had more incidence in coronary artery disease than other age group which was statistically significant ( p=0.035). 61-75 years age group in group-B patients had coronary artery disease than other age groups which was statistically not significant(p=0.084). Patients of group-A was significantly relation with coronary artery disease (p>.001) and six times greater coronary artery disease than patients of group-B (OR= 6.15, 95% CI for OR =2.074 -18.289). Conclusions: In this way the importance of appropriate glycaemic control has been emphasized in diabetic patients. This study showed the relation between HbA1c levels and the severity of CAD in patient with type-II diabetes mellitus .Our findings demonstrate that elevated HbA1c level was risk factor for severity of coronary artery disease in ACS patients. Bangladesh Heart Journal 2018; 33(2) : 80-84


2014 ◽  
Vol 71 (5) ◽  
pp. 474-480 ◽  
Author(s):  
Predrag Djuric ◽  
Zorica Mladenovic ◽  
Aleksandra Grdinic ◽  
Dragan Tavciovski ◽  
Zoran Jovic ◽  
...  

Background/Aim. The FINish Diabetes RIsk SCore (FINDRISC) which includes age, body mass index (BMI), waist circumference, physical (in) activity, diet, arterial hypertension, history of high glucose levels, and family history of diabetes, is of a great significance in identifying patients with impaired glucose tolerance and a 10-year risk assessment of developing type 2 diabetes in adults. Due to the fact that the FINDRISC score includes parameters which are risk factors for coronary artery disease (CAD), our aim was to determine a correlation between this score, and some of its parameters respectively, with the severity of angiographically verified CAD in patients with stable angina in two ways: according to the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score and the number of diseased coronary arteries. Methods. The study included 70 patients with stable angina consecutively admitted to the Clinic of Cardiology, Military Medical Academy, Belgrade. The FINDRISC score was calculated in all the patients immediately prior to angiography. Venous blood samples were collected and inflammatory markers [erythrocyte sedimentation rate (ESR), leucocytes, C-reactive protein (CRP), total cholesterol, HDL cholesterol, triglycerides and fasting glucose] determined. Coronary angiography was performed in order to determine the severity of coronary artery disease according to the SYNTAX score and the number of affected coronary vessels: 1-vessel, 2-vessel or 3-vessel disease (hemodynamically significant stenoses: more than 70% of the blood vessel lumen). The patients were divided into three groups regarding the FINDRISC score: group I: 5-11 points; group II: 12-16 points; group III: 17-22 points. Results. Out of 70 patients (52 men and 18 women) enrolled in this study, 14 had normal coronary angiogram. There was a statistically significant positive correlation between the FINDRISC score and its parameters respectively (age, body mass index-BMI, waist circumference) and the severity of CAD according to the SYNTAX score (p < 0.001) and the number of diseased coronary arteries (p < 0.001). The patients with higher FINDRISC score (groups II and III) had more severe and extensive CAD according to the SYNTAX score than the group I. The odds ratio with 95% confidence intervals (CI) between the group III and the group I was 5.143 (95% CI 1.299-20.360, p = 0.002) and between the group II and the group I 5.867 (95% CI 1.590- 21.525, p = 0.007). There were no differences in odds ratio for multivessel disease according to FINDRISC score between the group II and the group III [1.141; (95% CI 0.348-3.734). In the group I mean SYNTAX score was 5.18, and more than 70% of patients had normal coronary angiogram. In the group II mean SYNTAX score was 17.06, and more than 70% of patients had 2-vessel disease and 3- vessel disease, and in the group III mean SYNTAX score was 18.89, and 2-vessel and 3-vessel disease had 36.36% and 31.82% patients, respectively. In multiple regression analysis, where SYNTAX score was dependent variable, and age, BMI, waist circumference, FINDRISC score were independent variables, we found that only FINDRISC score was independent predictor of SYNTAX score. Conclusion. The obtained results suggest a statistically significant correlation between the FINDRISC score and its parameters (age, BMI, waist circumference) and the severity of CAD according to the SYNTAX score and the number of diseased coronary arteries. The FINDRISC score may be useful in identifying patients at the high risk for coronary artery disease.


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