ASSOCIATION OF ST ELEVATION IN LEAD AVR WITH LEFT MAIN STEM AND TRIPLE VESSEL DISEASES IN PATIENTS WITH NON-ST ELEVATION MYOCARDIAL INFARCTION

Objectives: To determine frequency of left main stem (LMS) and triple vessel coronary artery disease (3VCAD) in patients of Non-ST-elevation myocardial infarction (NSTEMI) and to compare the frequency of LMS and 3VCAD in patients with NSTEMI with or without ST elevation in lead aVR. Methodology: Total 346 patients with NSTEMI having age 30-70 years were included in this descriptive cross-sectional study. The data on demographic details was collected. All patients underwent electrocardiography (ECG) and cardiac specific troponin-I assessment. Patients were categorized as NSTEMI with or without ST-elevation in lead aVR. Coronary angiography was performed in all patients and angiographic findings were noted. Results: Mean age of patients was 51.87±10.03 years. There were 218 (63.01%) males and 128 (36.99%) female patients. 182 (52.60%) patients of NSTEMI had ST elevation in aVR. LMS disease was found in 53 (29.10%) patients with ST elevation in aVR. Sensitivity, specificity, positive predive value and negative predictive value of ST elevation in aVR for LMS disease was 62.35%, 50.57%, 29.12% and 80.49% respectively. 3 VCAD was found in 54 (29.70%) with ST elevation in aVR. Sensitivity, specificity, positive predive value and negative predictive value of ST elevation in aVR for 3VCAD was 77.14%, 53.52%, 29.67% and 90.24% respectively. Conclusion: NSTEMI patients with ST elevation in aVR may have higher chances of having LMS disease or 3VCAD. There is high negative predictive value for ST elevation in aVR to predict LMS disease or 3VCAD.

Successful rotational atherectomy of left main stem with double kiss crush stenting using double guiding catheter: a case report

Background Coronary artery bypass grafting (CABG) is the preferred revascularization procedure for patients with multivessel disease, and those with complex left main disease, as it is associated with a survival advantage in this group of patients. Sometimes however surgical management is not the treatment of choice due to many factors including; ongoing chest pain, hemodynamic instability or patient preference. In these situations, PCI offers an alternative revascularization strategy. In this case study, we present a successful PCI with rotational atherectomy (RA) for distal LMS, LAD and CX using a double guide catheter technique in a patient with severe calcific disease. Case Summery A 63-year-old female was diagnosed with a non-ST elevation myocardial infarction (NSTEMI). Coronary angiography showed significant distal left main stem disease with a severe proximal/ostial calcified lesion of the LAD and a possible thrombotic lesion at the ostium of the CX. She had ongoing hemodynamic instability with chest pain however could not be offered immediate surgical revascularization. We therefore elected to proceed to complex bifurcation LMS coronary intervention using RA under IVUS guidance achieving an excellent final result with TIMI III flow. Discussion This case demonstrates that rotational atherectomy (RA) using the double catheter technique (also known as Ping-Pong) can be safely performed with minimal complication rates and with very favorable angiographic and IVUS results. The clinical outcome was excellent with early discharge.

Frequency of significant carotid artery disease on carotid angiography in patients with left main stem coronary artery disease.

Objectives: To determine the frequency of significant carotid artery disease on carotid angiography in patients presenting with left main stem coronary artery disease. Study Design: Cross Sectional study. Setting: Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad. Period: October 2016 to April 2017. Material & Methods: 140 patients were included in this study. To diagnose carotid artery disease, carotid angiography was performed. Imaging was performed while subjects were lying in a supine position. Arterial access gained through femoral artery and using Headhunter carotid angiography catheter (6F). Lateral, AP and ipsilateral oblique views was obtained. Results: Age ranges between 40-75 years with mean age of 53.91±7.05 years. There were 94 (67.2%) male patients while remaining 46 patients (32.8%) were female. Carotid artery disease was found in 54 patients (38.6%). Stratification with regard to gender and age was carried out. Conclusion: In conclusion, frequency of carotid artery disease in patients with left main stem coronary artery disease is high in our population. Therefore, screening of carotid artery disease should be recommended in patients with CAD, especially in older patients with multivessel CAD.

Prevalence of Left main coronary artery disease with diabetes and hypertension in STEMI patients

Aim: To determine the association of left main stem disease with diabetes and hypertension in STEMI patients underwent coronary angiography Methodology: This study was conducted at Department of Cardiology, Sheikh Zayed Hospital, Lahore during January to June 2019 where 220 patients with age ranging from 40-70 years whether male or female, presenting with STEMI, In Exposed Group: Patients presenting with STEMI having diabetes and hypertension and Unexposed Group: Patients of STEMI without diabetes and hypertension. We excluded all cases with recurrent MI or undergoing recurrent PCI (on medical record), valvular heart disease, and cardiogenic shock. Then two groups were formed i.e. exposed group with diabetes and hypertension and unexposed group without diabetes and hypertension. All patients underwent angiography by a senior consultant cardiologist with assistance of researcher. On angiography, presence of LMS disease was ≥50% occlusion (stenosis) in LMS artery. Angiography reports were assessed and LMS disease was noted labeled. Patients with LMS disease was managed as per hospital protocol. Results: In this study risk of LMS was higher among exposed group as compared to un exposed group. i.e. exposed: 19.1% & Unexposed: 5.5%, RR=3.50 The risk of LMS among exposed group was higher for patients in the age group 51-60 years (RR=8.00), for male patients (RR=5.76) risk for LMS was higher as compared to female patients in exposed group, patients with normal BMI (RR:2.20) and patients with shorter duration of STEMI in exposed group had higher risk for LMS (1-4 weeks: RR=7.54). Conclusion: Results of this study showed that hypertensive and diabetic patients presenting with STEMI had higher risk for LMS disease. Keywords: Left main stem, Diabetes, Hypertension, Coronary, Angiography