Survival of patients treated with intra-aortic balloon counterpulsation at a tertiary care center in Pakistan – patient characteristics and predictors of in-hospital mortality

BACKGROUND: Intra-aortic balloon counterpulsation (IABC) has an established role in the treatment of patients presenting with critical cardiac illnesses, including cardiogenic shock, refractory ischemia and for prophylaxis and treatment of complications of percutaneous coronary interventions (PCI). Patients requiring IABC represent a high-risk subset with an expected high mortality. There are virtually no data on usage patterns as well as outcomes of patients in the Indo-Pakistan subcontinent who require IABC. This is the first report on a sizeable experience with IABC from Pakistan. METHODS: Hospital charts of 95 patients (mean age 58.8 (± 10.4) years; 78.9% male) undergoing IABC between 2000–2002 were reviewed. Logistic regression was used to determine univariate and multivariate predictors of in-hospital mortality. RESULTS: The most frequent indications for IABC were cardiogenic shock (48.4%) and refractory ischemia (24.2%). Revascularization (surgical or PCI) was performed in 74 patients (77.9%). The overall in-hospital mortality rate was 34.7%. Univariate predictors of in-hospital mortality included (odds ratio [95% CI]) age (OR 1.06 [1.01–1.11] for every year increase in age); diabetes (OR 3.68 [1.51–8.92]) and cardiogenic shock at presentation (OR 4.85 [1.92–12.2]). Furthermore, prior CABG (OR 0.12 [0.04–0.34]), and in-hospital revascularization (OR 0.05 [0.01–0.189]) was protective against mortality. In the multivariate analysis, independent predictors of in-hospital mortality were age (OR 1.13 [1.05–1.22] for every year increase in age); diabetes (OR 6.35 [1.61–24.97]) and cardiogenic shock at presentation (OR 10.0 [2.33–42.95]). Again, revascularization during hospitalization (OR 0.02 [0.003–0.12]) conferred a protective effect. The overall complication rate was low (8.5%). CONCLUSIONS: Patients requiring IABC represent a high-risk group with substantial in-hospital mortality. Despite this high mortality, over two-thirds of patients do leave the hospital alive, suggesting that IABC is a feasible therapeutic device, even in a developing country

Political riots in Pakistan and stress-induced cardiomyopathy: a case report

A previously healthy middle-aged lady with no prior risk factors for coronary artery disease presented with chest discomfort and ECG changes suggestive of anterolateral ST elevation myocardial infarction. She had had a stressful event prior to the onset of symptoms in that she had been caught up in a riot and had been exposed to intense mental and physical stress. She was found to have severe global left ventricular dysfunction but coronary artery disease was not discovered on coronary angiography. She was treated with antiplatelets, statins, diuretics and aldosterone antagonists. Her left ventricular function was revealed to have improved to normal as shown on echocardiography done on her follow-up 2 months after initial presentation

Congenital absence of left circumflex artery with a dominant right coronary artery

Case 1: a 40-year-old man was admitted to our hospital with progressively worsening post myocardial infarction angina. Cardiac catheterisation was performed, which showed total occlusion of the left anterior descending artery (LAD) and the left circumflex artery (LCX) was not visualised. The right coronary artery (RCA) was a large artery supplying the left ventricular inferior and posterolateral walls and filling the LAD artery in retrograde. The patient was referred for coronary artery bypass grafting. Peroperative findings confirmed the angiographic evidence of congenitally absent LCX artery

Drug eluting stents: data from a clinical registry

Objective: To assess the characteristics and short-term outcome of patients, undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES), in routine clinical practice.Design: Observational study.PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, from 2002 to 2003.PATIENTS AND Methods: All the patients who underwent PCI with DES at cath lab, AKUH, during the year 2002 and 2003 were included. Data was collected from database and by reviewing clinical records. Follow-up data for a period of 6-9 months was collected from the clinical records and by a telephone interview where required.Results: A total of 141 patients underwent PCI with DES at AKUH during the year 2002 and 2003. This study was predominantly male dominated (approximately 77%), with a mean age of 55+/-11 years. Thirty-nine percent were diabetics, and 53% were hypertensives. Twelve percent of patients had prior coronary artery bypass graft surgery (CABG) and 17% had prior PCI. Two or more than two lesions were attempted in 55% of patients. Majority (84.4%) of lesions were moderate to high risk category. Six to nine months follow-up was available in 133 (94%) patients. The only death was due to heart failure in the presence of a patent stent. Nearly 8% had clinical angina and 3.8% had myocardial infarction (MI) during follow-up. Target lesion revascularization (TLR) was performed in 4.6%. Major adverse cardiac events (MACE), defined as death, MI, and TLR occurred in 6.8% of patients.CONCLUSION: This data shows that DES are being used in a broad variety of clinical settings in routine or real life clinical practice. The outcome is excellent and comparable to randomized trials