Objectives: This study aimed to compare the efficacy and safety of Drug-Eluting Balloons (DEB) versus Drug-Eluting Stents (DES) in the treatment of In-Stent Restenosis (ISR) among patients with Stable Ischemic Heart Disease (SIHD). Methodology: A retrospective observational study was conducted from October 2023 to October 2024 at a tertiary care center. A total of 200 patients were enrolled-100 treated with DEB and 100 with DES. Baseline demographic, clinical, and angiographic characteristics were assessed. The primary outcome was the incidence of Major Adverse Cardiovascular Events (MACE) at 12 months, defined as a composite of cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR). Secondary outcomes included rates of restenosis and repeat revascularization. Statistical analyses were performed using SPSS version 26, with p-values < 0.05 considered statistically significant. Results: At the 12-month follow-up, the DEB group demonstrated a significantly lower incidence of MACE (16%) compared to the DES group (24%) (p = 0.04). Restenosis occurred in 18% of the DEB group versus 28% of the DES group (p = 0.03). TLR rates were 10% in the DEB group and 15% in the DES group (p = 0.32), while repeat revascularization was observed in 14% of DEB patients versus 21% of DES patients (p = 0.06). These findings suggest a clinical advantage of DEB in ISR management. Conclusion: DEB may be a superior alternative to DES in reducing the risk of MACE and restenosis in patients with ISR. Further randomized controlled trials are recommended to substantiate these findings and guide clinical decision-making.

Objectives: This updated meta-analysis aimed to consolidate clinical evidence comparing the clinical outcomes of intravascular ultrasound (IVUS)-guided LMCA stenting versus conventional angiography-guided LMCA stenting.Methodology: We included "randomized controlled trials" and "observational studies" published in peer-reviewed English language journals that compared the clinical outcomes of LMCA revascularization using "drug-eluting stents (DES)" via "IVUS-guided" versus "angiography-guided" stenting. The primary outcome of interest was "major adverse cardiovascular events (MACE)", while secondary outcome variables included "all-cause mortality", "myocardial infarction (MI)", "target vessel/lesion revascularization (TVR/TLR)", and "stent thrombosis (ST)". Risk ratios (RRs) for each outcome variable were calculated using the "Mantel-Haenszel method".Results: The analysis included nine studies involving a total of 5,344 patients, with 2,282 undergoing "IVUS-guided" LMCA stenting and 3,062 undergoing "angiography-guided" LMCA stenting. "IVUS-guided" LMCA stenting showed a significant reduction in the risk of MACE compared to "angiography-guided" LMCA stenting, with a RR of 0.46 [95% CI: 0.27 - 0.79]. However, a high level of heterogeneity (I2=94%; p<0.01) was observed among the included studies. Additionally, "IVUS-guided" LMCA stenting was associated with significant reductions in all-cause mortality, MI, and ST, with RRs of 0.38 [0.21 - 0.66], 0.45 [0.26 - 0.77], and 0.24 [0.10 - 0.57], respectively. There was no statistically significant difference in TVR/TLR between "IVUS-guided" and "angiography-guided" LMCA stenting, with an RR of 0.64 [0.27 - 1.51].Conclusion: "IVUS-guided" LMCA revascularization using DES was associated with a lower risk of MACE, death, MI, and ST compared to conventional "angiography-guided" LMCA stenting.

Objective: The research aimed to examine the relationship between kidney dysfunction and the occurrence of slow blood flow or no-reflow phenomenon and insufficient ST-segment resolution after the percutaneous coronary intervention procedure in individuals suffering from ST-elevation myocardial infarction. Methods: In a retrospective analysis conducted at Hayatabad Medical Complex Peshawar, for six months, 210 consecutive patients have undergone percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). The term slow-flow/no-reflow referred to an angiogram result of TIMI Grade <3 after the implantation of a stent, despite a residual stenosis of less than 50%, and with no major damage or visible blood clots. Results: The study included 210 patients, with 185 (88.0%) having normal flow and 25 (11.9%) having slow flow/no-reflow after PCI. Comparison between patients with normal flow and those with slow flow or no-reflow. Male sex was more common in the LVEF ≥50% group compared to the LVEF <50% group (84.2% vs. 74.0%, p=0.043). Practical Implication: Overall, the practical implications of this study can positively impact the community by enhancing risk assessment, patient management, treatment approaches, communication, and future research in the context of renal dysfunction and PCI outcomes in STEMI patients. Conclusion: The study found that patients with STEMI who have renal dysfunction are more likely to experience SFR and ISR after undergoing PCI. We should regard renal dysfunction as a significant factor that increases the risk of these complications. Treatment may need to be more intensive to achieve better results in these patients. Keywords: Renal dysfunction, slow-flow/no-reflow phenomenon, inadequate ST-segment resolution,

Background Prodromal symptoms are warning signs of an impending acute myocardial infarction (AMI). However, they are often overlooked by both patients and primary clinicians, and little is known about them. Therefore, this study aims to assess the frequency and types of prodromal symptoms in patients with AMI. Methodology This descriptive cross-sectional study was conducted at a tertiary care cardiac center. Consecutive patients diagnosed with AMI within the last week were evaluated for prodromal symptoms. The prodromal symptoms included chest pain, chest heaviness, chest burning, palpitations, fatigue, sleep disturbance, shortness of breath (SOB), dizziness, anxiety, sudden heat or cold, back pain, and vomiting. Results In a sample of 242 patients, 79.6% were males, with a mean age of 54.7 ± 12.2 years, and 179 (74%) were diagnosed with ST-segment elevation myocardial infarction (STEMI). Among the participants, 142 (58.7%) showed no prodromal symptoms. Among those with prodromal symptoms, chest pain was the predominantly reported prodromal symptom with a frequency of 68%, followed by chest heaviness at 44%, palpitations at 42%, shortness of breath at 34%, and chest burning at 27%. Unusual fatigue in 23% and sleep disturbance in 22% of the patients were also reported. Conclusion The findings from this study revealed that prodromal symptoms were present in a significant proportion of acute myocardial infarction (MI) cases, with more than four in 10 patients reporting these early warning signs. The most commonly observed prodromal symptoms were chest pain, chest heaviness, palpitations, shortness of breath, and chest burning. The timely identification of these symptoms can help prevent infarction, thereby reducing the burden of heart failure and other related mortalities.

This study aimed to monitor the impact of counseling on adherence in hypertensive patients. Patient adherence was measured using the Hill-Bone medication adherence scale; non-adherent participants were counseled regarding antihypertensive medicines. The counseling impact was measured among enrolled participants. Most participants were male (n = 135), and only five were transgender. 52% of patients were from rural areas, and 48% were from urban areas. The 70 participants were intermediate and passed only 23. 38% of study participants were unemployed, while 26% were government employees. The 116 patients were 61–70 years old, while only 29 participants were 71–80. 33% of participants were prescribed 5 drugs, whereas no reported patient was prescribed one drug. Extremely low adherence was observed before counseling, whereas excellent results were achieved after patient counseling regarding antihypertensive medicines. To date, no study exists to measure adherence to antihypertensive medications. This study will help the doctors to counsel the patients so that patients will take the medications according to the prescription. The adherence rate of hypertensive patients can be improved if the patients are properly counseled regarding antihypertensive medicines.

Objective: The objective of current research was to identify the compliance of commonly prescribed antithrombotic drug among patients who suffering from Deep Vein Thrombosis (DVT). Methodology: Descriptive cross-sectional research on adults with age of 18-65 years suffering from DVT were conducted on medicine department of Shaheed Mohtarma Benazir Bhutto Medical University Hospital of Larkana. Three hundred and forty eight DVT patients were consecutive selected during the period of six months from January 2021 to June 2021. Data of DVT patients was collected by using standard proforma and analyzed with statistical package of social sciences (SPSS) version 25. Results: Majority of DVT patients evaluated during study period were male 237 (61.7%) patients and 147 (38.3%) DVT patients were female. Mean age of DVT patients was 43.78 ± 12.43 (18-65) years. Most of the patients were in age group of 51-65 years having 126 (32.8%) patients followed by 41-50 years having 104 (27.1%) patients, 31-40 years having 93 (24.2%) patients and 18-30 years having 61 (15.9%) patients. Majority of DVT patients were from urban areas 217 (56.5%) patients followed by rural areas 167 (43.5%) patients. Drug compliance in illiterate patients was 107 (36.1%). Drug compliance in indoor job patients was 102 (34.5%) whereas drug compliance in jobless patients was 59 (19.1%). Drug compliance in positive medication history was 207 (69.9%). Drug compliance in Hypertensive patients was 33 (11.1%) in congestive heart failure patients 27 (9.1%), in ischemic stroke 15 (5.1%). Whereas, the drug compliance among diabetes mellitus patients was 13 (4.4%). Overall drug compliance with antithrombotic drugs was reported in 296 (77.1%) DVT patients. Conclusion: Current research concludes that rate of drug compliance was high in patients of DVT with rivaroxaban followed by warfarin and heparin, whereas long duration of therapy, polypharmacy, side effects of therapy, cost of therapy, continuous monitoring, injectables, diet restrictions and ADRs of therapy were the most commonly reported factors of non-compliance.

Objectives: The objective of current research was to identify the compliance of antithrombotic drug (heparin, warfarin and Rivaroxaban) and factors of non-compliance associated with heparin, warfarin and rivaroxaban. Methodology: A cross-sectional, observational study was conducted on patients suffering from Deep Vein Thrombosis (DVT) at government teaching hospital of Larkana. 348 DVT patients were selected by using online sample calculator software. Data was collected by using pre validated questionnaire after taking patient consent; finally the data was analyzed with statistical package of social sciences (SPSS) version 25. Results: The compliance with rivaroxaban was present in 103 (80.5%) patients followed by heparin drug compliance in 95 (74.2%) DVT patients and warfarin drug compliance in 98 (76.6%) DVT patients. Non-compliance factors with rivaroxaban were; cost in 4 (16.0%) patients, polypharmacy in 6 (24.0%) patients, side effects in 4 (16.0%) patients and prolong therapy in 11 (44.0%) patients. Non-compliance factors with heparin were; monitoring in 13 (39.4%) patients, diet restriction in 6 (18.2%) patients, injectable in 10 (30.3%) patients and ADR in 4 (12.1%) patients. Non-compliance factors with warfarin were; cost in 4 (13.3%) patients, polypharmacy in 8 (26.7%) patients, prolong therapy in 5 (16.7%) patients and ADR in 13 (43.3%) patients. Conclusion: This study concludes that rate of drug compliance was high in patients of DVT with rivaroxaban followed by warfarin and heparin, whereas long duration of therapy, polypharmacy, side effects of therapy, cost of therapy, continuous monitoring, injectables, diet restrictions and ADRs of therapy were the most commonly reported factors of non-compliance.

Objective This study aimed to assess the duration of pre-hospital delay among ST-Segment Elevation Myocardial Infarction (STEMI) patients and its contributing factors. Methodology A cross-sectional study was conducted at Rural Satellite Center in Larkana, Pakistan from May to September 2020. A total of 240 STEMI patients who underwent primary percutaneous coronary intervention (P-PCI) were included. The patients' demographic characteristics, index event characteristics, mode of transportation, misinterpretations, misdiagnoses, and financial problems were recorded. Data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Results The observed pre-hospital time was 120 minutes; 229 (median; interquartile range [IQR]). It was found that 33.3% of patients arrived within one hour of the symptom onset, while 20.4% of patients delayed hospital arrival for more than six hours. The delay rate was highest among patients aged 41 to 65 years. Moreover, delayed admissions were more common among females as compared to males (p=0.008). Among the causes of delay in hospital arrival were misinterpretation, misdiagnosis, and transportation and financial issues. Of these, misdiagnosis significantly influenced the delay rate, i.e., more than 50% of the misdiagnosed patients arrived hospital after six hours of symptom onset (p<0.05). Conclusion The P-PCI rural satellite center had a positive impact as the observed pre-hospital delay rate was considerably less as compared to that reported in the existing literature. Moreover, the confounding factors were misdiagnosis and misinterpretations. We need to develop the concept of immediate appropriate help-seeking among patients.

Objective: Acute pulmonary edema (APE) is a common problem presenting in emergency department of cardiology units. For decades, the mainstay of treatment in APE has been loop diuretics; mainly furosemide. Studies regarding mortality benefits of diuretics in APE patient have not been conducted in our population, where other drugs of heart failure are not frequently available. Therefore, results of our study may provide justification for continued use of diuretics as mainstay treatment of APE. Aim of this prospective study was undertaken to determine the relationship between dose of furosemide and mortality. Methodology: This prospective study was conducted at department of cardiology, SMBBMU, Larkana from June 2017 to December 2017. Patients of either gender, aged between 18 to 75 years presenting with diagnosis of APE were included in the study. Patients were followed up till time of discharge or death. Outcome variable i-e mortality was noted and recorded. Results: A total of 402 patients were included in this study out of which 234 (58.2%) were males. In-hospital mortality was 17.9% (77). Total amount of diuretics used was significantly lesser among the patients who died (209.28 ± 134.15 ml vs. 295.18 ± 151.43 ml; p-value <0.001). Patients who received less than 300mg/day diuretics had increased mortality as compared to those who received more than 300 mg/day (59 (20.3%) vs. 13 (11.7%); p-valve 0.045). Conclusion: Patients who received less diuretic had more mortality than those who received more diuretic.

Introduction: Patients having a cardiovascular disease experience negative states of psychology. An increased incidence of coronary artery disease is attributed to both depression and anxiety. Materials and methods: In this retrospective study, the Hospitalized Anxiety and Depression Scale (HADS) was used to determine anxiety and depression in stable patients of myocardial infarction (MI) at the time of their discharge. All responses were based on the patients’ perceptions two weeks prior to acute MI event. SPSS version 21.0 was used for data entry and analysis. Results: The mean age of the participants in our study was 49.09±5.61 years. About 52.83% (n=28) and 58.49% (n=31) participants suffered from anxiety and depression two weeks prior to their myocardial infarction. Conclusion: Depression and anxiety can be a risk factor for myocardial infarction in susceptible individuals. Attention should be given to mental well-being, and a multi-disciplinary management approach should be taken for these patients including psychiatry and psychology.