Analyzing Prescribing Pattern of Evidence-Based Medications for Coronary Artery Disease Management in a North Indian Tertiary Care Center

Abstract: The incidence of coronary artery disease (CAD) is increasing at an alarming rate, especially in developing countries, such as India. It is often advocated that a vegetarian lifestyle could reduce the burden of CAD. However, in spite of a majority of Indians being vegetarians, the incidence of CAD is highest in this population. This may be due to deficiency of vitamin B12, a micronutrient, sourced only from animal products.: Herein, we assessed the effect of vitamin B12 with respect to CAD in 816 individuals (368 CAD patients and 448 controls) recruited from a tertiary care center in New Delhi, India.: We found that vitamin B12 levels were significantly lower in CAD patients than in controls (p<0.0001). Also, vegetarians were found to have significantly lower vitamin B12 concentrations (p=0.0001) and higher incidence of CAD (p=0.01). Interestingly, elevated homocysteine levels, a hallmark of vitamin B12 deficiency, was not associated with CAD. In contrast, cysteine levels were significantly higher in CAD patients than in controls (p=0.004).: We believe that, when vitamin B12 is deficient, homocysteine is rapidly metabolized via the transsulfuration pathway leading to increased cysteine levels.Clin Chem Lab Med 2009;47:334–8.

Download Full-text

Study of risk factors associated with adverse outcome in a severe coronary artery disease (syntax score >22) with different therapeutic strategies

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20193253 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1021

Author(s):

Vidur G. Karnik ◽

Yogesh B. Patil ◽

N. Pai ◽

M. N. Bhat ◽

R. L. Kamath ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Care Center ◽

Tertiary Care ◽

Therapeutic Strategies ◽

Syntax Score ◽

Significant Difference ◽

Therapeutic Procedures ◽

Artery Disease

Background: The specific question of whether PCI or surgical treatment offers any advantage over MT in patients with stable angina and multivessel disease remains unanswered. Objective of our research was to study various risk factors which interferes the outcome of various therapeutic procedures in coronary artery disease.Methods: This was prospective observational study carried out in a tertiary care center from July 2014 to July 2016. A total of 98 subjects undergoing different therapeutic strategies were followed up. Risk factors which interferes the outcome of various therapeutic procedures in coronary artery disease (CAD) were studied.Results: There was a significant difference in mean SYNTAX score (P = 0.003), urine micro albumin levels (P=0.006), and body mass index (0.046) between those who had MACE and who did not have MACE.Conclusions: The urine micro albumin >30 mg/l and highest SYNTAX score were significantly associated with MACE at 1 year in subject with severe CAD.

Download Full-text

Primary angioplasty in acute myocardial infarction: initial experience in a developing country

Journal of Transcatheter Interventions ◽

10.31160/jotci202129a202105 ◽

2021 ◽

Vol 29 ◽

pp. 1-6

Author(s):

Miguel Vicente ◽

Roger Dopico ◽

Luís Domingos ◽

Tomás Peralta ◽

Valdano Manuel ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Acute Myocardial Infarction ◽

Coronary Artery ◽

Care Center ◽

Tertiary Care ◽

Coronary Intervention ◽

Primary Angioplasty ◽

Health Concern ◽

Artery Disease

Background: Coronary artery disease is a major public health concern worldwide. In Africa, varying rates of progression increased in different countries. In Angola, although the epidemiological scenario is dominated by infectious diseases, the prevalence of coronary artery disease is increasing with notable impacts, requiring the creation of mechanisms to face this reality in a country where lack of specific infrastructure is still a challenge. The objective of this study was to describe the experience of primary angioplasty in patients with acute myocardial infarction in an Angolan tertiary care center. Methods: This was a descriptive, longitudinal, retrospective study, involving 165 patients diagnosed with acute myocardial infarction between 2012 and 2019. Variables were age, sex, risk factors, angiographic and procedure-related characteristics, and main complications. Results: The mean age was 58.3±6.8 years, and males predominated (75.8%). Hypertension (69.7%), dyslipidemia (35.2%), smoking (32.7%) and diabetes (29.7%) were more prevalent. The anterior location was the predominant topography of infarction (49.7%). Single vessel disease was the most common pattern (50.9 %). The left anterior descending artery was the most often involved vessel (49.7%). The door-to-balloon time was 46.6±32.4 minutes. In the multivariate analysis, anterior myocardial infarction (p=0.033), diabetes (p=0.004), age ≥60 years (p≤0.001) and post-coronary intervention final TIMI flow Conclusion: Percutaneous coronary intervention in the context of acute myocardial infarction in Angola is a reality, but the number of procedures performed is not enough given the current great demand.

Download Full-text

Frequency of ABO Blood Group and its Association with Acute Coronary Syndrome in Patients Presenting in a Tertiary Care Center of Nepal

Journal of Institute of Medicine ◽

10.3126/jiom.v42i1.37427 ◽

2020 ◽

Vol 42 (1) ◽

pp. 49-53

Author(s):

Surya R Pathak ◽

Sunil C Jha ◽

Ratna M Gajurel ◽

Chandra M Poudel ◽

Hemant Shrestha ◽

...

Keyword(s):

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Blood Group ◽

Care Center ◽

Tertiary Care ◽

Abo Blood Group ◽

Coronary Syndrome ◽

Increased Risk ◽

Artery Disease

Introduction Coronary artery disease is the major cause of death all over the world. There are studies suggesting association between blood group and coronary artery disease. We attempted to study the frequency of ABO blood group and its association with acute coronary syndrome (ACS) in our hospital. MethodsThis is a retrospective, cross sectional study carried out in Manmohan Cardiothoracic Vascular and Transplant Centre from March 2018 to February 2019. Patients who were admitted with diagnosis of ACS were enrolled in the study. Data were recorded and analyzed using SPSS 20. Association between blood group and ACS was analyzed using chi square test and logistic regression. ResultsTotal 430 patients were admitted with diagnosis of ACS during the study period, of which 307 (71.4 %) were male and Mean age was 61.22 years (±10.75). Blood group O was the most common type of blood group observed in 207 (48%) patients. ACS was significantly higher in blood group O compared to other groups after adjusting for normal ABO blood group prevalence in general population: blood group O vs. A (OR: 3.45, 95% CI: 2.48- 4.79, p- <0.001), blood group O vs. B (OR: 5.08, 95% CI: 3.53-7.33, p- <0.001), blood group AB vs. O (OR: 0.65, 95% CI: 0.41- 1.02, p- 0.064). Individuals with blood group O and B had increased risk of having STEMI and NSTEMI where as those with blood group A had increased risk of having unstable angina. ConclusionThere was association between ABO blood group and coronary artery disease. Individuals with blood group O have increased incidence of ACS.

Download Full-text

Evaluation of prescribing pattern of drugs use in patients of coronary artery disease at a tertiary care hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20183491 ◽

2018 ◽

Vol 7 (9) ◽

pp. 1792

Author(s):

Mahesh N. Belhekar ◽

Tejal C. Patel ◽

Mohit Kumar Singh ◽

Prasad R. Pandit ◽

Kiran A. Bhave ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Ace Inhibitors ◽

Tertiary Care Hospital ◽

Beta Blockers ◽

Tertiary Care ◽

Evidence Based ◽

Care Hospital ◽

Artery Disease

Background: Coronary artery disease (CAD) is a major cause responsible for mortality more in younger age group than in elderly. Studies have reported underuse of four evidence based medicines namely aspirin, β-blockers, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and statins in patients with CAD, particularly in developing countries. Therefore, this study was planned to analyse the prescriptions of patients with CAD to determine the appropriateness of the prescriptions.Methods: After obtaining the Institutional ethics committee permission, a cross sectional observational study was conducted at a tertiary care hospital. Total 150 patients were enrolled from the outpatient department, wards and intensive care unit of medicine department. Total 150 patients’ prescriptions presenting with varied category of CAD were screened and analysed.Results: The most common categories of CAD encountered was ST segment elevated myocardial infarction (N=50, 33%) followed by chronic stable angina (N=29, 20%). Among the drugs prescribed, antiplatelet drugs were prescribed to 135 (90%), hypolipidemics to 134 (89%), nitrates to 114 (76%), beta blockers to 97 (65%), ACE inhibitors to 94 (64%), anticoagulants to 60 (40%) and miscellaneous drugs to 52 (35%), patients. Of 68 (45%) patients with type 2 diabetes mellitus, 15 (22%) were prescribed only metoprolol and others were given ACE-I or ARBs.Conclusions: Among four evidence based drugs, use of 3 drugs, antiplatelets, beta blockers and hypolipidemics was apparent in 90% of prescriptions. Use of ACE inhibitors and ARBs was observed in type 2 diabetic patients with CAD, reflecting rational prescribing behavior of clinicians.

Download Full-text

Clinical and demographic profile of patients presenting to cath-lab in a tertiary care center in Nepal

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v11i1.13313 ◽

2015 ◽

Vol 11 (1) ◽

pp. 1-5

Author(s):

Utsav Shrestha ◽

Subrat Khanal ◽

Pranita Ghimire ◽

Nikesh R Shrestha

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Care Center ◽

Tertiary Care ◽

Significant Risk ◽

Health Science ◽

Age Group ◽

Artery Disease ◽

Invasive Evaluation ◽

Single Vessel Disease

Background & Objectives: Coronary Artery Disease (CAD) is one of the leading killers in the world. This is a demographic study of patients who underwent coronary angiography for CAD with regard to sex, age, ethnicity and prevalence of risk factors.Materials & Methods: Hospital based retrospective study conducted at the Department of Internal Medicine, B.P. Koirala Institute of Health Science (BPKIHS), Dharan, Nepal.Results: The Study showed that out of 382 patients who presented to the cath-lab 216 patients underwent angiography alone and 166 patients had PCI. The most common indication for presentation to cath-lab was S-T Elevation Myocardial Infarction (STEMI), which accounted for 46.3% cases. The most common age group of presentation was 51-60 years of age with 35% cases. During the procedure, it was found that 32.8% had normal vessels, 29.6% had single vessel disease and 38% had 2 or more vessels involved. The most common coronary artery involved was left anterior descending (LAD), which was implicated in 96.9 % of total cases. Coronary Artery Disease was defined as having at least one vessel 50% obstructed. A total of 158 males and 99 females had CAD with a sex ratio of 1.59. It was found that 36.1% belonged to Brahmin / Chettri ethnicity whereas 34.0% belonged to Janjati. Hypertension was the most common risk factor, present in 67 % of the patients.Conclusion: It appears that among the population of eastern Nepal, the age group most likely to suffer from an episode of ACS leading to invasive evaluation is between 50 to 60 years. And the most significant risk factors associated are hypertension and smoking.JCMS Nepal. 2015;11(1):1-5

Download Full-text