Frequency of Patients with Coronary Artery Disease Achieving Optimal Glycemic Control at Tertiary Care Hospital, Karachi

Objective: To determine frequency of glycemic control in patients with coronary artery disease (CAD) visiting to National Institute of Cardiovascular Diseases, Karachi. Study Design: Descriptive Cross-Sectional study Place and Duration: This study was conducted at Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan for six months duration from 12th October 2019 to 11th April 2020. Methodology: One hundred and ten patients of both gender with coronary artery disease were enrolled in this study. Informed consent was taken after explaining the procedure, risks and benefits of the study. In our study, all the included patients were given the emergency treatment and their blood samples were sent to laboratory to assess the outcome variable i.e. glycemic control. All the data was analyzed by SPSS 24.0. Results: Mean ± SD of age was 62.5±8.4 years. Out of 110 patients, 65 (59.1%) were male while 45 (40.9%) were female. Obesity was found in 41 (37.3%) patients. Glycemic control was noted in 20 (18.2%) patients. Conclusion: It is to be concluded that less glycemic control was noted among coronary artery disease (CAD) patients with increasing prevalence of diabetes. Indicators of quality care (HbA1c & other complications) should be assessed regularly for better diabetes management. Keywords: Glycemic Control, Coronary Artery Disease, Type 2 Diabetes, Risk Factors

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Abstract P050: Association Between Glycemic Control and Short-term Mortality Varies Across the Spectrum of Coronary Artery Disease

Circulation ◽

10.1161/circ.135.suppl_1.p050 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Sridharan Raghavan ◽

Wenhui G Liu ◽

P. Michael Ho ◽

Mary E Plomondon ◽

Anna E Baron ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Glycemic Control ◽

Diabetes Management ◽

Significant Risk ◽

Short Term ◽

Increased Risk ◽

Short Term Mortality ◽

Artery Disease

Background: Diabetes is a significant risk factor for cardiovascular disease, but optimal glycemic control strategies remain unclear. In particular, trials of intensive glycemic control have highlighted a tension between increased mortality risk and macrovascular benefits. In this study we aimed to assess whether the burden of coronary artery disease (CAD) modifies the association between glycemic control and short-term mortality. Methods: We studied veterans with diabetes who underwent elective cardiac catheterization between 2005 and 2013 in a retrospective analysis of data from the VA Clinical Assessment, Reporting, and Tracking (CART) Program. Primary exposures were time-varying HbA1c over two years of follow-up after index catheterization, categorized as <6%, 6-6.49%, 6.5-6.99%, 7-7.99%, 8-8.99%, and >=9%, and burden of CAD, categorized as no CAD, non-obstructive CAD, or obstructive CAD. Primary outcome was two-year all-cause mortality. A total of 17394 participants had, on average, five HbA1c measurements over two years of follow-up. We used multivariable Cox proportional hazards regression to estimate the association between HbA1c and mortality, adjusting for demographic and clinical covariates and CAD burden, and including a term for interaction between HbA1c and CAD burden. Results: In adjusted models with 6.5 ≤ HbA1c ≤ 6.99% as the reference category, HbA1c < 6% was associated with increased risk of mortality (HR 1.55 [1.25, 1.92]), whereas HbA1c categories above 7% were not. We observed significant interaction between glycemic control and CAD burden (interaction p=0.0005); the increased risk of short-term mortality at HbA1c < 6% was limited to individuals with non-obstructive and obstructive CAD (Figure 1). Conclusions: HbA1c below 6% was associated with increased risk of short-term mortality, but only in individuals with CAD. CAD burden may thus inform individualized diabetes management strategies, specifically treatment de-escalation in individuals with any angiographically-defined CAD.

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To Determine the Frequency of Extent of Coronary Artery Disease (CAD) with Troponin-I level >10 folds ULN in NSTEMI Patients at Tertiary Care Hospital

10.53350/pjmhs211592757 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2757-2762

Author(s):

Vinesh Kumar ◽

Fawad Ali Siddiqui ◽

Kiran Irfan ◽

Muhammad Adeel Qamar ◽

Ghulam Jaffar Shah ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Troponin I ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Vessel Disease ◽

The Mean ◽

Artery Disease ◽

Single Vessel Disease

Introduction: Higher levels of troponins >10 folds of upper normal limits (UNL) are considered as high-risk patients on coronary angiography sufferers having high levels of troponin-I (>10 folds upper limit normal level) had extra three-vessel coronary artery disease involvement. Objectives: To determine the frequency of degree of cardiovascular disease with Troponin-I level >10 folds ULN in NSTEMI patients at tertiary care hospital. Methodology: It is a cross-sectional study comprising of a total 800 patients recruited from the Department of Cardiology, National Institute of Coronary Disease, Karachi Pakistan based on Exclusion/Inclusion criteria. Results: There are 678 male as well as 122 female patients. The mean troponin-I level was 15.00±6.82 ng/ml. Single vessel disease found in 25.25% cases, two vessel diseases were observed in 37.75% cases, and three vessel diseases were observed in 20% cases. 83% were found with extent of CAD findings on angiography. There have been 678 male and also 122 female patients. The mean troponin-I level was 15.00±6.82 ng/ml. Single vessel disease found in 25.25% cases, two vessel diseases were observed in 37.75% cases, and three vessel diseases were observed in 20% cases. 83% were found with extent of CAD findings on angiography. Conclusion: The higher troponin level found significantly associated with extent of CAD and three vessel disease. To understand the cardiovascular troponin condition of the sufferer as soon as feasible is crucial. Keywords: Extent of Coronary Artery Disease, NSTEMI, Troponin-I Level >10 Folds ULN

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Chest Pain in Emergency Department Patients: If the Pain is Relieved by Nitroglycerin, is it More Likely to be Cardiac Chest Pain?

CJEM ◽

10.1017/s1481803500013671 ◽

2006 ◽

Vol 8 (03) ◽

pp. 164-169 ◽

Cited By ~ 9

Author(s):

Robert Steele ◽

Timothy McNaughton ◽

Melissa McConahy ◽

John Lam

Keyword(s):

Coronary Artery Disease ◽

Emergency Department ◽

Chest Pain ◽

Coronary Artery ◽

Diagnostic Test ◽

Tertiary Care ◽

Positive Likelihood Ratio ◽

Care Hospital ◽

Artery Disease

ABSTRACT Introduction: It is often believed that chest pain relieved by nitroglycerin is indicative of coronary artery disease origin. Objective: To determine if relief of chest pain with nitroglycerin can be used as a diagnostic test to help differentiate cardiac chest pain and non-cardiac chest pain. Design: Prospective observational cohort study with a 4-week follow-up of patients enrolled. Setting: Academic tertiary care hospital, with 60 000 visits/year. Inclusion criteria: Adult patients presenting to the emergency department with active chest pain who received nitroglycerin and were admitted for chest pain. Exclusion criteria: Patients with acute myocardial infarction diagnosed after obtaining an ECG, patients whose chest pain could not be quantified, those for whom no cardiac work-up was done, or those who received emergent cardiac catheterization. Results: 270 patients were enrolled. Nitroglycerin relieved chest pain in 66% of the subjects. The diagnostic sensitivity of nitroglycerin to determine cardiac chest pain was 72% (64%–80%), and the specificity was 37% (34%–41%). The positive likelihood ratio for having coronary artery disease if nitroglycerin relieved chest pain was 1.1 (0.96–1.34). Telephone follow-up at 4 weeks was performed, with a 95% follow-up rate. Conclusions: Relief of chest pain with nitroglycerin is not a reliable diagnostic test and does not distinguish between cardiac and non-cardiac chest pain.

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A CASE STUDY ON CLINICAL PHARMACIST INTERVENTIONS IN THE MANAGEMENT OF DIABETES COMPLICATED CORONARY ARTERY DISEASE IN HEALTH-CARE PRACTICE

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i4.36742 ◽

2020 ◽

pp. 1-4

Author(s):

BHARATH KUMAR A ◽

UMASHANKAR MS

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Clinical Pharmacist ◽

Tertiary Care ◽

Ankle Brachial Index ◽

Care Practice ◽

Final Visit ◽

Care Hospital ◽

Pharmacist Interventions ◽

Artery Disease

Objective: The objective of the study was to assess the clinical pharmacist interventions in the management of diabetes complicated coronary artery disease. Methods: In the present study, a case history of a 55-year-old female was suffering from diabetes with coronary artery disease was taken. The case was collected from the cardiology outpatient department in a tertiary care hospital. The case was analyzed from 1 to 3 months. The initial visit to the end of final visit her laboratory parameters was examined at the laboratory. Results: The test report of electrocardiogram revealed sinus rhythm. The patient was advised for an echocardiogram which confirmed coronary artery disease. The patient was subjected to a coronary angiogram, which revealed the presence of double-vessel disease. Her ankle-brachial index study test revealed peripheral artery disease. The patient was diagnosed with coronary artery disease, and she was prescribed with regular medications. The patient was monitored for 1-week duration and prescribed with coronary artery disease medications to normalize the condition. The patient was improved with the treatment and advised for regular follow-ups. Conclusion: The study concludes that there was an imperative need for regular health screening by the physician associated clinical pharmacist care services with an effective treatment modality that can reduce the coronary artery disease incidences in this patient.

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