Clinical outcomes after percutaneous coronary intervention in patients with coronary artery disease: six months results from a single centre study

Background: The study aimed to evaluate clinical outcomes in patients with coronary artery diseases (CAD) who underwent percutaneous coronary intervention (PCI), to identify the factors associated with clinical outcomes and survival among such patients, to explore the procedure related complications, and to assess restenosis and stent thrombosis rates following PCI.Methods: This retrospective, single-center, observational study was conducted at a tertiary-care center in India, which included patients with CAD undergoing PCI from January 2016 to December 2016. Angiographic and clinical success and complications related to both procedural and vascular access were noted. Patient were followed-up for clinical outcomes up to 6-months. Primary outcome of the study was all-cause mortality. Secondary outcome measures were cardiovascular mortality, and event free survival, angina, cardiovascular events and restenosis and stent thrombosis.Results: A total of 831 patients were included of which majority were males (83.5%). Smoking was found in 33.7%, diabetes in 35.6%, and hypertension in 37.7%. At 6-months, follow-up was obtained for 711 patients. The clinical composite endpoint seen in 9.8% of patients. Angina (13.2%), acute coronary syndrome (3.1%), stent thrombosis (1.0%), in-stent restenosis (3.9%), cardiovascular and all-cause mortality (2.7%), heart failure (7.3%) and stroke (1.7%) were reported at 6-months follow-up.Conclusions: The PCI in a tertiary-care centre leads to low rates of periprocedural events and low rates of clinical outcomes at 6-months follow-up. Moreover, left ventricular ejection fraction was shown to be major predictor for cardiovascular mortality in post-PCI patients. Hypertension was significantly associated with stroke post-PCI

Contact tracing for COVID-19 in a healthcare institution: Our experience and lessons learned

During the initial phases of the COVID-19 pandemic contact tracing was used to control spread of the disease. It played a key role in health care institute which continued to work even during lockdown. In this piece of work, we share the lessons learnt from the contact tracing activity done in the health care institution during April to July 2020. The training needs of persons involved in contact tracing, the follow of activities, use of technology, methods to fill the missing gaps were the key lessons learnt. Its documentation supports in setting up contact tracing activity for any emerging infectious disease outbreaks in future

Effects of subcutaneously infiltrated nitroglycerin on diameter, palpability, ease-of-puncture and pre-cannulation spasm of radial artery during transradial coronary angiography

Background: The success of transradial catheterization depends on meticulous access of radial artery which in turn depends on palpating a good radial pulse. Objectives: Our objectives were to analyze the effects of subcutaneously infiltrated nitroglycerin on diameter of radial artery, palpability of radial pulse, ease-of-puncture and pre-cannulation spasm of radial artery during transradial coronary angiography. Methods: Patients undergoing transradial coronary angiography were randomized to Group NL or Group SL. In Group NL, 3 ml of solution containing nitroglycerin and lignocaine was infiltrated subcutaneously at the site intended for puncture of radial artery. Similarly, saline and lignocaine were infiltrated in Group SL. Diameter of radial artery was objectively assessed by ultrasonography. Measurements were performed at baseline and repeated at 1 min after injecting the solutions. The ease-of-puncture was evaluated by the number of punctures and the time needed for successful access of radial artery. Results: Both groups had 100 patients each. Baseline diameter of radial artery was similar between two groups. The post-injection diameter of radial artery increased by 26.3% in Group NL and 11.4% in Group SL. Nitroglycerin significantly improved the palpability of radial pulse, reduced the number of punctures and shortened the time needed for successful access of radial artery. Pre-cannulation spasm of radial artery occurred in 1% of Group NL and 8% of Group SL. Conclusions: Subcutaneously infiltrated nitroglycerin leads to significant vasodilation of radial artery. This avoids pre-cannulation spasm of radial artery, enhances palpability of the radial pulse and thus makes the puncture of radial artery easier

Coronary sinus diameter by echocardiography to differentiate atrioventricular nodal reentrant tachycardia from atrioventricular reentrant tachycardia

Background: Coronary sinus (CS) has been shown to be larger in patients with atrioventricular nodal reentrant tachycardia (AVNRT). We sought to determine if echocardiographically measured CS diameter can help identify the mechanism of tachycardia in patients with narrow complex tachycardia without preexcitation before the invasive electrophysiology study.Methods: Forty four patients with documented narrow complex, short RP tachycardia who were scheduled for an electrophysiology study were included. Based on the electrophysiology study, patients were divided into those with AVNRT and those with a concealed accessory pathway and atrioventricular reentrant tachycardia (AVRT). Proximal CS diameter (CSp) measured at the ostium and mid CS diameter (CSm) 1 cm distal to the ostium using transthoracic echocardiography.Results: CSp was significantly larger in patients with AVNRT than AVRT (14.1 ± 5 vs. 9.9 ± 2 mm, p < 0.0001). CSm diameter was not significantly different between the two groups. A cut-off of CSp > 11.2 mm identified AVNRT with a sensitivity of 92.6% and specificity of 76.9%. CSp was a better discriminant (AUC 0.89, 95% CI 0.75–0.97) compared to age (AUC 0.74, 95% CI 0.58–0.87) or tachycardia rate (AUC 0.60, 95% CI 0.44–0.76).Conclusions: Echocardiographic measurement of the diameter of CS ostium can help in identifying the mechanism of the tachycardia before the invasive electrophysiology study.

Safety and outcomes of day care based coronary angioplasty – First report from India

Background: The concept of day care based coronary angioplasty might be frugal especially in countries like India where epidemic of coronary disease is enduring and healthcare delivery systems are limited. Published literature addressing the feasibility and safety of day care percutaneous coronary interventions (PCI) is lacking from our country. Objectives: To study the safety and outcomes in stable cardiac patients undergoing day care coronary angioplasty. Methods: A single centre nonrandomized active controlled trial of patients undergoing elective transradial coronary angioplasty and same day discharge after triaging was compared with a conventional arm of hospital overnight stay. Results: Fifty six patients with stable coronary artery disease underwent day care angioplasty. There were no major immediate adverse cardiac and cerebral events noted in the first 24 h. The procedural result followed by a 6-h observation period allowed adequate triage of patients to same-day discharge or to extended clinical observation. Apart from one possible stent thrombosis on day 3 in the treatment arm where the patent received fibrinolytic treatment in a local hospital, there were no major adverse cardiac or cerebral vascular events in the study group. The six month clinical follow up in the day care procedure group was also unevenful for any major adverse cardiac events. Conclusion: The study albeit small shows the feasibility and safety of day care PCI in the Indian scenario. It did not lead to additional complications compared with overnight stay. Triage of patients for an extended observation period can be performed adequately on the basis of clinical and procedural criteria

Cardiac syndrome X: Clinical characteristics revisited

Background: Cardiac syndrome X includes a heterogenous group of patients with angina but normal epicardial coronaries in angiography. Objective: Our objective was to study the clinical characteristics of patients with cardiac syndrome X. Methods: Data of patients who underwent coronary angiography over a period of one year was retrospectively analyzed. Those with normal or non-obstructive coronaries in angiography with chest pain were included in this study. Results: 1203 patients underwent coronary angiography during the study period. 105 (8.7%) patients fulfilled the inclusion criteria. There were 52 (49.5%) males and 53 (50.5%) females including 31 (29.5%) postmenopausal women. Many patients had atherosclerotic risk factors. Typical angina and atypical chest pain were reported by 63 (60%) and 42 (40%) patients, respectively. ECG was normal in 46 (43.8%) and abnormal in 59 (56.2%) patients. The most common abnormal finding in ECG was ST-T changes seen in 49 (46.7%) patients. Regional wall motion abnormality with mild left ventricular systolic dysfunction was seen in 4 (3.8%) patients while 101 (96.2%) patients had normal ventricular function in echocardiography. TMT was positive for inducible ischemia in 35 (33.3%) patients and inconclusive in 10 (9.5%) patients. Angiography showed normal epicardial coronaries in 85 (80.9%) patients. Conclusions: Cardiac syndrome X constitutes a significant subset of patients undergoing coronary angiography. It is essential to identify and treat them specifically for microvascular angina. Many of them have atherosclerotic risk factors but their presentation is different from those with obstructive coronaries