Clinical and angiographic profile in patients of western Rajasthan undergoing percutaneous coronary interventions: a single centre experience

Background: This study was aimed to evaluate clinical and angiographic profile of patients undergoing percutaneous coronary intervention at the Department of Cardiology, Mathura Das Mathur (MDM) Hospital attached to Dr. Sampurnanand Medical College, Jodhpur.Methods: This study was hospital based prospective observational study conducted in the department of cardiology at MDM hospital. This study included 1166 patients who underwent percutaneous coronary intervention at cardiac cathlab of MDM hospital from January 2016 to April 2017. Procedural details noted included vascular access route, lesion characteristics, number of lesions intervened, stents used and periprocedural pharmacotherapy administered.Results: A total of 1166 patients (mean age- 56.3±10.4 years) with 76.5% male and 23.5% female were included in the study. Smoking and hypertension were the most common risk factors, present in 64% and 56% patients respectively. Diabetes mellitus and obesity were observed in 24.5% , 18.0% patients respectively. Anterior wall MI was the most common mode of presentation (36.2%). Single Vessel Disease (SVD) was the most common angiographic pattern observed in 62% patients; left anterior descending artery (LAD) was the most frequently involved vessel (65.9%); and type B lesions were most prevalent (48%). Most of the procedures were elective (61.4%) and femoral route was used in the majority (76%). Radial access was obtained in 24% of patients. Primary PCI was done in 6% of cases while pharmaco-invasive approach was adopted in 32.6% of patients. Drug eluting stents were deployed in 100% of the cases. The overall procedural success rate was 95.4%. Procedural mortality was nil and periprocedural complications occurred in 16.0% patients.Conclusions: This first PCI study from western Rajasthan provides an overview into the salient features of CAD among regional population and focus on the characteristics of PCIs performed with their outcomes

Anomalous left coronary artery from pulmonary artery in an adult

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac anomaly that can cause myocardial infarction, heart failure and even death in paediatric patients. Only few untreated patients survive till adulthood. Here we present the case of a 28-year-old lady with exertional dyspnoea and chest pain who was diagnosed to have ALCAPA

Pattern of congenital heart diseases in Western Rajasthan: an echocardiographic study

Background: Congenital heart disease (CHD) accounts for nearly one third of all major congenital anomalies. Globally the prevalence of CHD is 1.01 to 17.5 per 1000 live births. In India it is 1.3 to 26.4 per 1000 study population. CHD is an important cause of mortality and morbidity representing a global health burden. Early diagnosis and treatment may lead to improved prognosis in patients suffering from CHD. The aim of this study was to assess the pattern of CHD in Western Rajasthan, India by echocardiography.Methods: This was a retrospective study carried out at Dr. S. N. Medical College and attached group of hospitals in Jodhpur, Rajasthan, India. The study period was from July 2014 to June 2017. Records of all patients undergoing transthoracic echocardiography from newborn to 25 years of age were analyzed for age, sex and CHD findings.Results: In the study period, a total of 24,914 patients underwent echocardiography, of which 877 patients were identified as having CHD. Prevalence of CHD was 35.20 per 1000 study population. Amongst the total diagnosed CHD cases, 489 (55.76%) patients were male, with male to female ratio of 1.2:1. CHDs were diagnosed more commonly between 1 month and 1 year of age (41.28%). The commonest type of acyanotic CHD in the present study was ventricular septal defect (21.44%) and cyanotic CHD was tetralogy of Fallot (18.24%).Conclusions: Prevalence of CHD in Western Rajasthan, India was 35.20 per 1000 study population. Profile of CHDs in the present study was similar to that in published literature

Comparison of electrocardiogram diagnostic criteria in diagnosis of left ventricular hypertrophy using 3 D echocardiography as standard

Background: The echocardiogram (ECHO) has a better diagnostic performance for left ventricular hypertrophy (LVH) than the electrocardiogram (ECG), but ECG is most widely used diagnostic method. We aimed to assess the correlation between ECG based diagnosis of LVH with echocardiography-based diagnosis of LVH as standard. Methods: Patients with evidence of LVH using echocardiographic criteria were included in the study. Patients were subjected to four electrocardiographic criteria to assess the LVH: 1. Sokolow-Lyon criteria; 2. Romhilt and Estes scoring system; 3. Cornell voltage criteria; and 4. Gubner voltage criteria. After assessing the results of ECG and echocardiography diagnostic validity tests (by calculating specificity and sensitivity), the Kappa measure of agreement was performed. Results: In maximum patients (52.8%) LVH was detected by using ECG LVH Sokolow Lyon criteria, followed by Cornell voltage CR criteria that detected LVH in 38.9% cases. Sokolow Lyon ECG criteria showed high sensitivity while Romhilt and Estes criteria showed maximum 98% specificity in diagnosing LVH. Sokolow Lyon’s ECG criteria was highly sensitive in assessing all co-morbidities, except CKD where it was diagnosed better by using Cornell voltage criteria. Conclusions: In cases of diagnosing LVH in patients with co-morbidities, ECG LVH Sokolow Lyon CR was found to be the most sensitive criteria except CKD where it was diagnosed better by using Cornell voltage criteria. For assessing the patients for LVH, the role of ECG with all the commonly used criteria is of limited value and ECHO should be the method of choice.

Long term prognostic significance of thrombolysis in myocardial infarction risk score after revascularization in non-ST elevation acute coronary syndrome

Background: Non-ST elevation acute coronary syndrome (NSTE-ACS) patients are complex and varied population. Primarily thrombolysis in myocardial infarction (TIMI) risk score was developed to guide therapy and assess the short term (14 days) prognosis of these patients. However, few studies have evaluated the long term prognostic significance of TIMI risk score after revascularization. This study aims at assessing the long term prognostic significance of TIMI risk score, 36 months after revascularization in NSTE-ACS.Methods: This was a retrospective observational cohort study of consecutive NSTE-ACS patients (n=150) treated by percutaneous coronary intervention between January 2017 to June 2017 in a tertiary care center. TIMI risk score was calculated for each patient at admission. The primary endpoint was a composite of MACE (death, repeat target-vessel revascularization, and non-fatal recurrent MI) at the end of 36 months of follow up. Clinical secondary endpoints included the individual components of the primary endpoint, death, nonfatal recurrent MI, and repeat target vessel revascularization.Results: Baseline characteristics for 150 participants were as follows, age 56±9.5 years, 78.7% male, 25% diabetics, 82% hypertensives, and 36% had hypercholesterolemia. The event rates of the primary endpoint and its components after 36 months were 26.6%. Event rates increased significantly as the TIMI risk score increased as determined by regression analysis (p=0.004). The relative risk increased by 66% as the TIMI risk score increased from low risk category (TIMI score 0-2) to high risk (TIMI score 5-6).Conclusions: TIMI risk score can be used for long term prognostication of NSTE-ACS patients after revascularization, and thus can be used by clinicians for therapeutic decision making

Clinical outcome of proximal left anterior descending revascularization with everolimus eluting stents via transradial route: a single centre experience in Western Rajasthan, India

Background: The proximal left anterior descending (LAD) artery stenosis represents the most important proximal site for obstructive coronary artery, as it supplies 40%–50% of the total left ventricular myocardium and could result in ischemia to a large area of myocardium. This study assesses the clinical outcome of patients with coronary artery diseases undergoing percutaneous revascularization with everolimus eluting stent implantation in the proximal left anterior descending coronary artery via trans radial route.Methods: 150 patients with significant angiographic lesion of proximal LAD artery stenosis treated with PTCA and stenting to proximal LAD via TRA were selected for study and were followed for one year.Results: Total 15 events were recorded 4 (2.6%) deaths and 11 (7%) MI and TLR was noted in 4% of patients. One (0.6%) case of acute stent thrombosis was recorded.Conclusions: Total MACE of this record (10% at 12 months of clinical follow-up) is consistent with those observed in the large randomized and multi-center studies with drug-eluting stents implanted in the proximal left anterior descending artery

Percutaneous transcatheter intervention in a cyanotic congenital heart disease at tertiary care hospital in Western Rajasthan: a single centre experience

Background: Treatment of congenital heart disease (CHD) is either surgical or interventional. Medical management is mainly symptomatic or palliative. Although surgery is the main mode of treatment but in the recent past non-surgical interventional method is replacing it because of its multiple advantages over surgical procedures. In this article, we report the success rate of the percutaneous transcatheter device closure procedures in our tertiary care hospital.Methods: The aim of this study is to review the short-term outcome of the non-surgical interventional treatment of congenital heart diseases. We included percutaneous transcatheter device closure of atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA) and ruptured sinus of valsalva aneurysm (SVA) performed at our hospital between September 2014 and November 2016.Results: We performed total 28 cases of ASD device, 3 cases of VSD device, 12 cases of PDA device, 2 cases of ruptured SVA device closures. Almost all our intervention procedures were successful except two cases of failure of ASD closure. There was no mortality and major complication related to procedures. All patients of successful interventional treatment are enjoying new life without any morbidity.Conclusions: Percutaneous transcatheter device closure for suitably selected cases of a cyanotic CHDs including ASD, VSD, PDA and ruptured SVA may be an alternative, lucrative, safe and effective option with least morbidity and mortality

Endovascular management of chronic mesenteric ischemia: a single centre experience in Western Rajasthan, India

Background: Chronic mesenteric ischemia (CMI) or mesenteric angina is a condition characterised by inadequate blood supply to bowel as a result of stenosis affecting   one or more of the three mesenteric arteries: the celiac artery (CA), the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA).Methods: Ten patients with significant lesion, treated with PTA and stenting were selected for study and were followed at 2 weeks, at 2 months then at 6 months after index procedure to see composite of symptomatic improvement, weight gain and revascularization.Results: On mesenteric angiography, significant ostial stenosis of celiac trunk and superior mesenteric artery in 5 patients, 3 patients had significant ostial stenosis of celiac trunk and ostial stenosis of inferior mesenteric artery and 2 patients had significant stenosis of superior mesenteric artery. Percutaneous transluminal angioplasty (PTA) and stenting was done, final result was good and there was no residual stenosis and dissection. After stenting patients were stable and pain free. There were no post-operative complications. Follow up was done after 2 weeks and 2 months and then at six months. There was no postprandial abdominal pain on follow up and almost all patient had gained weight in 2 months and on 6 months of follow up, no case of repeat revascularization was recorded.Conclusions: Percutaneous transluminal angioplasty (PTA) and stenting to mesenteric artery is good alternative management of CMI. In present series, all cases were susses fully revascularized without residual stenosis and dissection

Pattern of rheumatic heart disease in Western Rajasthan- an echocardiographic study: a single centre experience

Background: Rheumatic heart disease (RHD) is a common form of heart valve disease associated with episodes of rheumatic fever. Despite the developments achieved in the field of cardiology, the consequences of acute rheumatic fever remain significantly high in developing countries like India.  Objectives of current study aims to evaluate the pattern of valvular involvement in patients of RHD in Western Rajasthan assessed by echocardiography.Methods: This is an observational study conducted at the department of Cardiology, Dr. S. N. Medical College, Jodhpur, India between September 2015 and February 2019. The study includes analysis of echocardiograms of RHD patients performed during this period.Results: Total 502 echocardiograms of RHD patients between 4 and 75 years of age with mean age of 35.6±11.6 years were evaluated, in which the most common age group was 21-40 years.  There were 191 (38.04%) males, and 311(61.95%) females. Mitral valve was most commonly involved in which mitral stenosis (MS) was seen in 345(68.72%) and mitral regurgitation (MR) was seen in 350(69.72%) patients. Aortic stenosis (AS) was seen in 61(12.15%) and aortic regurgitation (AR) was found in 224(44.62%) cases. Organic tricuspid valve (TV) disease was seen in 18(3.58%). In combined valvular involvement MS+MR was seen in 234(46.61%) cases; followed by MR+AR in 171(34.06%); MS+AR in 161(32.07%); AS+AR in 62(12.35%); MR+AS in 46(9.16%) and MS+AS in 42(8.36%) subjects.Conclusion: The echocardiographic pattern of RHD patients of Western Rajasthan showed a predominant involvement of mitral valve, followed by aortic and tricuspid valves. Further amongst multi-valvular involvement the sequence was predominantly MS+MR followed by MR+AR, MS+AR, AS+AR, MR+AS, and MS+AS

Evaluation of clinical outcome of thrombolytic therapy in elderly patients in Western Rajasthan: a single centre experience

Background: Heart disease is the leading cause of mortality in population above the age of 65 years. Severity and prevalence of coronary artery disease (CAD) increase with increasing age. Thrombolysis remains the standard of care in the management of acute ST-elevation myocardial infarction (STEMI) in developing countries like India where primary percutaneous coronary intervention (PCI) is still not possible in the majority of patients. The risks and benefits of thrombolytic reperfusion therapy among the elderly patients with STEMI is much less known. Authors aimed to evaluate the outcome and complications of thrombolytic therapy in elderly patients admitted with acute STEMI.Methods: The present observational study was done between January 2017 and January 2019 in the department of cardiology, Dr. S.N. Medical College, Jodhpur, India. It included a study group comprising 102 consecutive elderly patients who had acute STEMI and underwent thrombolytic therapy and a control group comprising 102 consecutive elderly patients who had STEMI who were not given thrombolytic therapy. Both groups were evaluated for an outcome (in-hospital mortality) and complications.Results: The overall in-hospital mortality was less in thrombolytic therapy group as compared to control group although not statistically significant (8.82% versus 14.70%, p=0.277). Similarly, in-hospital mortality was less in thrombolytic therapy subgroup A (age 66-74 years) as compared to control subgroup A (6.45% versus 10.75%, p=0.583) and also less in thrombolytic therapy subgroup B (age 75-85years) as compared to control subgroup B (12.50% versus 21.62%, p=0.445).  Among the traditional risk factors, co-morbid conditions and complications, there was less prevalence of diabetes mellitus (4.90% versus 15.68%, p=0.021), hypertension (5.88% versus 6.86%, p=1.000), cardiogenic shock (8.82% versus 9.80%, p=1.000), left ventricular failure (LVF) (0.98% versus 3.92%, p=0.365) and atrioventricular (AV) block (0% versus 4.90%, p=0.245) but more acute kidney injury (AKI) (2.94% versus 0%, p=0.070) in thrombolytic therapy group patients as compared to control group patients.  Cerebrovascular accident (CVA) did not occur in both group patients.Conclusion: Despite the higher prevalence of co-morbidities and high risk features in elderly patients of acute STEMI, timely thrombolysis is beneficial. A mortality benefit was seen in all groups suggesting net benefit regardless of increasing age up to the age of 85 years