A.R. Taksande

A.U. Mahajan

H. Shah

P.J. Nathani

U.B. Khedkar

Indian Heart Journal

Khedkar, U.B.

Taksande, A.R.

Shah, H.

Mahajan, A.U.

Nathani, P.J.

Elsevier - Publisher Connector 

Comparison of clinical profiles of patients with acute coronary syndrome (ACS) of the age above and below 40 years 

Test. Chronotropic response also significantly improved with
Ivabradine.
Conclusion: Combining Ivabradine with low dose Bisoprolol in
Stable Angina patients produces additional anti-anginal and anti-
ischaemic benefits and improves chronotropic reserve.
Significance of troponin levels in patients with
stable coronary artery disease
T. De, D. Kahali, J.C. Sharma, A. Mishra, K.K.H. Siddiqui
B.M. Birla Heart Research Centre, Kolkata, India
Background: This study was done to determine the significance of
Troponin release in patients with stable Coronary Artery Disease
(CAD) by comparing Troponin I levels with CT angiography char-
acteristics of atherosclerotic plaque.
Methods: Troponin I levels were determined in 50 consecutive
patients with Stable Angina, who underwent CT coronary angi-
ography (CTA) for clinical indications. CTA was used to assess: (1)
Coronary Calcification, (2) Stenosis Severity, (3) Non-Calcific Pla-
que Volume.
Results: In 10 patients, Troponin I was > 0.4 (range 0 - 0.34). Weak
correlation was found between Troponin I and Calcium scoring
p<0.001, r¼0.45 while a stronger correlation was found between
Troponin I and Total Non-Calcified Plaque Burden (p<0.001,
r¼0.79). Patients with non-calcific plaque had significantly higher
Troponin I values than those with normal vessels or those with
only calcified lesions.
Conclusion: Chronic clinically stent rupture of non-calcified pla-
que with micro-embolisation may be a potential source of
Troponin elevation. Thus Troponin I may serve as a biomarker for
“vulnerable” coronary lesions even in presumably stable Coronary
Artery Disease (CAD).
Duration of vascular dysfunction of brachial artery
and radial artery after trans-radial access for
coronary angiography
C. Guruchaithanya Kumar, Seshagiri Rao, O. Saisatish,
Ramakumari
NIZAMS Institute of Medical Sciences, Hyderabad, India
Background: Prior studies have demonstrated that Brachial Artery
endothelial dysfunction after trans-radial cardiac catheterization
for diagnostic coronary angiography. However, the duration of
this endothelial dysfunction was unknown.
Methods: A total of 30 patients who are undergoing coronary
angiogram through transradial route were included. Using high-
resolution Vascular Ultrasound Endothelium-dependent, flow-
mentioned vasodilation (FMD) and administration of sublingual
nitroglycerin (endothelium-independent dilatation) of Ipsilateral
Brachial Artery (IRA) & Ipsilateral Radial artery (IBA) was
measured before and at 6 and 24 h, one week and onemonth after
catheterization. The left-sided Brachial Artery (BA)& Radial Artery
(RA) served as a control.
Results: Baseline FMD was 14.2 ± 4.9% in the right BA, 14.0 ± 5.1 %
in the left BA (p ¼ 0.88) and baseline FMD was 14.2 ± 6.8% in the
right RA, 14.5 ± 6.2% in the left RA (p ¼ 0.85). BA FMD was signif-
icantly decreased in the right intervention armwhen compared to
control at 6 hours and 24 hours (4.9 ± 6.1% ,14.7 ± 5.3%, p value
0.000), (5.8 ± 7.2%, 15.1 ± 5.3%, p value 0.000). RA FMD at 6 hours
was 3.2 ± 5.5% in the right RA, 15.5 ± 6.4 % in the left RA (p value
0.000) and at 24 hours FMD of RA not statistically significant. BA &
RA FMD was at 1 week, 1 Month Test were not statistically sig-
nificant from the control. In contrast, both NMD response and
FMD/NMD ratio were unaffected by the intervention in the control
arm. Kaplan-Meier Curve was drawn for the probability of recov-
ery of BA & RA endothelial dysfunction after transradial inter-
vention showing that 98% FMD recovered at 30 days.
Conclusion: Trans-radial cardiac catheterization leads to vascular
endothelial dysfunction of the IBA with recovery of the vascular
diameter by one week post procedure.
Comparison of clinical profiles of patients with
acute coronary syndrome (ACS) of the age above
and below 40 years
U.B. Khedkar, A.R. Taksande, H. Shah, A.U. Mahajan, P.J. Nathani
LTMGH, Sion, Mumbai, India
Background: This study comparatively few studies have focused
on the epidemiology and clinical profile of ACS in young patients,
therefore this study was aimed to evaluate differences in risk
factors, demography, clinical presentation, complications,
angiographic finding & mortality in patients with acute coronary
syndrome of the age above & below 40 yrs.
Methods: This is a prospective study of 200 patients of ACS done in
tertiary health centre inMumbai. Patients were divided into below
& above 40 yrs of age. Data collected including the history, risk
factors ,mode of presentation ,duration of symptoms ,treatment
received and investigations done i.e. lipid profile, homocysteine,
,blood sugars ,Trop T, ECG, Chest X-ray, 2D echo, (CAG).
Results: Among 200 patients, 38 (19%) were young & 162 (81%)
were older than 40 yrs withMale: female sex ratio of 5.3:1 and 2.88:
1 respectively. Atypical mode of presentation was seen more
among the ACS patient above 40 yrs of age (33.7%) as compared
with the young patients (8 %). In STEMI patients, delayed pre-
sentation (>12 hrs of index pain) was seen in 30 patients in older
age group (18.2%) while same in young group was seen in
5(13.15%)patients ; commonest cause being delay in trans-
portation. Elderly were also more likely to have contraindications
for thrombolysis (20.37Vs 7.8 %) Commonest risk factor in young
group was tobacco consumption (73.68%) followed by dyslipide-
mia (36.8%),& in old group, HTN(58%) followed by DM(40.74%).,
Hyperhomocysteinemia was seen in 20 patients in young group
(52.63%) and in 31 (19.13%) in old group. Complications were seen
in total 58(29%) patients, young- 7 (18.42%) & old- 52 (32%) with
most common complication in young group was arrhythmias
while in older group it was acute pulmonary oedema .Mortality
was higher in elderly patient group (6.17Vs2.63%). Commonest
Angiographic finding in young patient was Single vessel disease
(52.63%). In older group double vessel disease was more common
40.12 % followed by single vessel disease in 30.86 %.
Conclusions: Though prevalence of ACS is more in elderly popu-
lation, young patients are also getting affected increasingly, but
with a bit different clinical profile. Younger often presented with
typical presentation, has different risk factor profile, received
early aggressive treatment, and had favourable outcomes. Pri-
mary prevention of smoking/tobacco, dyslipidemias and over-
weight should be more aggressively promoted in youngs.
i n d i a n h e a r t j o u rn a l 6 6 ( 2 0 1 4 ) s 1es 1 4 3S16


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Comparison of clinical profiles of patients with acute coronary syndrome (ACS) of the age above and below 40 years

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Comparison of clinical profiles of patients with acute coronary syndrome (ACS) of the age above and below 40 years

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