Objectives:To evaluate the admission neutrophil-to-lymphocyte ratio (NLR) for risk stratification for in-hospital outcomes and complications in non-ST-elevation acute coronary syndrome (non-ST-ACS) patients. Methods:We recruited consecutive patients with non-ST-ACS. The NLR was obtained and stratified as low, intermediate, and high-risk based on <3.0, 3.0-6.0, and >6.0, respectively. The new ST-T changes, arrhythmias, contrast-induced nephropathy (CIN), and mortality were recorded. Results:Median NLR was 3 [2.1-5.3] for 346 patients with 19.9% and 30.6% in high- and intermediate-risk group. New ST-T changes were observed in 3.5% (12) out of which 8, 3, and 1 patient in low, intermediate, and high-risk group (p = 0.424), respectively. Arrhythmias were observed in 5.8% (20) with 7, 5, and 8 patients in low, intermediate, and high-risk group (p = 0.067), respectively. CIN was observed in 4.9% (17) with 5, 5, and 7 in low, intermediate, and high-risk group (p = 0.064), respectively. In-hospital mortality was recorded in 1.4% (5) with 2 and 3 patients in high and low-risk group (p = 0.260), respectively. Conclusion:A significant number of non-ST-ACS patients fall in the high-risk category of NLR. Although, the association between NLR and in-hospital mortality and adverse events was not statistically significant but relatively higher rates of events were observed in high risk group.

Objective: To determine patients' knowledge, attitude, and practices, who have cardiovascular diseases including heart failure (acute or chronic), coronary artery disease, and peripheral arterial disease, toward influenza vaccination. Methodology: Based on the semi-structured questionnaire, 384 individuals with age range from 18 to 70 years with heart failure (acute or chronic), coronary artery disease, and peripheral arterial disease were assessed. Results: Out of 384, 344 patients consented to participate in the survey comprising of 43.6% males and 56.3% females. Those who were aware that Influenza is an illness along with its adverse consequences they or their families might suffer from are only 22 (6.2%), and only 14 (4.1%) are aware of the seriousness of the disease. The number of individuals prescribed vaccine by their physician was 34; with 17 (9.7%) obtaining the vaccine from a hospital, 4 (23.5%) from private clinics and 11 (64.7%) from a family doctor. In the last five years, only 17 (4.9%) people had received the vaccine. Conclusion: Influenza vaccination rate in patients with cardiovascular diseases is low, which warrant substantial efforts to improve patients' and physicians' knowledge, attitude, and practice. This has the potential to reduce morbidity, mortality (both cardiovascular and all-cause), recurrent hospitalization, and health-related cost.

Objectives: Peripheral arterial disease (PAD) is still underdiagnosed and undertreated diseases accounts for a considerable part of cardiovascular disease. Therefore, the objective of this study was to determine the pattern of vascular involvement in patients with lower extremity peripheral artery disease. Methodology: In this study we reviewed hospital record files and angiographic films of the patients’ undergone conventional peripheral angiography. Patterns of vascular involvement was assessed in terms of involved arterial segments, site (right, left, or both), size (%), and type of lesion (discrete, tubular, or diffused). Results: A total of 74 patients were included, out of which 60 (81.1%) patients were male. A majority, 85.1% (63), were diabetic, 78.4% (58) were hypertensive, 43.2% (32) were smokers, and 23% (17) had coronary artery disease. The most common involved location was superficial femoral (51.4%) followed by anterior tibial (45.9%), posterior tibial (45.9%), popliteal (21.6%), and peroneal (16.2%). Female patients had significantly higher rate of superficial femoral diseases as compare to the male patients with rate of 85.7% (12/14) vs. 43.3% (26/60); p=0.004 respectively. Conclusion: In conclusion, the most common risk factor for PAD was found to be diabetes and a significant number of patients were also found to have hypertension, and smoking. The most common involved segment was superficial femoral in our population followed by anterior tibial, posterior tibial, popliteal, and peroneal.

Background: Intracoronary epinephrine has been effectively used in treating refractory no-reflow, but there is a dearth of data on its use as a first-line drug in normotensive patients in comparison to the widely used adenosine. Methods: In this open-labeled randomized clinical trial, 201 patients with no-reflow were randomized 1:1 into intracoronary epinephrine as the treatment group and intracoronary adenosine as the control group and followed for 1 month. The primary end points were improvement in coronary flow, as assessed by TIMI (Thrombolysis in Myocardial Infarction) flow, frame counts, and myocardial blush. Secondary end points were in-hospital and short-term mortality and major adverse cardiac events. Results: In all, 101 patients received intracoronary epinephrine and 100 patients received adenosine. Epinephrine was generally well tolerated with no immediate table death or ventricular fibrillation. No-reflow was more effectively improved with epinephrine with final TIMI III flow (90.1% versus 78%, P =0.019) and final corrected TIMI frame count (24±8.43 versus 26.63±9.22, P =0.036). However, no significant difference was observed in final grade III myocardial blush (55.4% versus 45%, P =0.139), mean reduction of corrected TIMI frame count (−25.71±11.79 versus −26.08±11.71, P =0.825), in-hospital and short-term mortality, and major adverse cardiac events. Conclusions: Epinephrine is relatively safe to use in no-reflow in normotensive patients. A significantly higher frequency of post-treatment TIMI III flow grade and lower final corrected TIMI frame count with relatively better achievement of myocardial blush grade III translate into it displaying relatively better efficacy than adenosine. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04699110.

Background: Though the presence of three-vessel disease (3VD) among patients with non-ST Segment Elevation Myocardial Infarction (NSTEMI) is relatively common, very limited data is available regarding its clinical significance. The current study aimed to determine the frequency of 3VD among NSTEMI patients presenting at the tertiary care hospital of Karachi, Pakistan. Methodology: This cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi from August 15 2015 to February 15 2016 over a sample of 139 NSTEMI patients. Data regarding patients' baseline characteristics were recorded in a proforma. Coronary angiography was performed to determine the presence of 3VD. The frequency of occluded arteries and 3VD was also recorded and the collected data was then analyzed using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY, USA). Results: A total of 139 NSTEMI patients were enrolled in the study with a mean age of 50.47 ± 12.47 years. The majority of them were males (70.5%), mostly ≥ 40 years of age (67.6%). Among the comorbidities, 50.4% of patients had diabetes mellitus (DM), 61.9% were hypertensive and 30.9% had dyslipidemia. The overall frequency of 3VD among the enrolled NSTEMI patients was 30.2%. Three major arteries were found to be occluded; 68.3% NSTEMI patients had occlusion in the left anterior descending (LAD) artery, followed by right coronary artery (RCA) among 49.6%, 40.3% had left circumflex (LCX) artery occlusion, and 50.4% had diagonal and obtuse marginal (OM) artery occlusion respectively. Among the effect modifiers, no significant impact of age, gender, and smoking habits was observed on the frequency of 3VD among NSTEMI patients (p > 0.05). Among the reported comorbidities, DM was significant among NSTEMI patients with 3VD (p < 0.05). Conclusion: Our study results indicated that a significant proportion of NSTEMI patients had 3VD, independent of the effect of age and gender.