Objective: To determine the rate of adverse outcome in patients with at least five TIMI scores after primary percutaneous coronary intervention. Methods: We conducted this descriptive study at National Institute of Cardiovascular Diseases Karachi for six months. This study included 200 men and women with chest pain who presented to the emergency department with chest pain and ST-segment elevation myocardial infarction. PCI processes were executed by cardiologists, and any post-procedure adverse outcomes were noted throughout the hospital stay. Results: A total of 200 participants were involved, 167 (83.5%) being males, and 33 (16.5%) being females. There were 95 (47.5%) moderate risk cases and 105 (52.5%) high-risk cases based on the TIMI scores. In the survey of patient outcomes, death occurred in 18.5% of cases, heart failure was observed in 43 cases (21.5%), cardiogenic shock was observed in 27 cases (13.5%), and ventricular arrhythmia was observed in 44 (22%) cases. Practical Implication: This research on the outcomes of primary PCI in patients with a TIMI score of five or higher can provide valuable information for healthcare providers, leading to improved patient selection, enhanced treatment decision-making, tailored interventions, reduced morbidity and mortality rates, and increased cost-effectiveness in managing myocardial infarction cases. These practical implications can significantly benefit the community by improving patient outcomes and optimizing healthcare resource utilization. Conclusion: A TIMI risk score of five or higher can also identify patients who may have heart failure, cardiogenic shock, and ventricular arrhythmias. Keywords: Primaryipercutaneous coronary intervention, thrombolysis, myocardial infarction, score of five or higher.

Objective: The object of our research was to determine whether intra-aortic balloon pump-assisted PCI improved overall clinical outcomes during hospitalization, as well as to predict in-hospital mortality and cardiogenic shock. Methods: This retrospective study was carried out at National Institute of Cardiovascular Diseases Karachi. We enrolled 60 consecutive patients with a history of AMI complicated by cardiogenic shock. These patients underwent PCI with insertion of an IABP between 1st September 2019 and 28th February 2020. Patients with cardiogenic shock would have better survival if the IABP was inserted before PCI rather than after PCI was performed. The prospective study included 60 patients (33 patients received IABP before PCI, before and 27 after PCI) suffering from cardiogenic shock complicating acute myocardial infarction who underwent PCI with IABP. SPSS version 23.0 was used to analyze all the data. Results: Based on the type of treatment, we divided individuals into two groups in our study. The IABPs were inserted before PCI in 33 patients in group A, and the pumps were started after PCI in 27 participants in group B. It was significantly different regarding the 30-day mortality rate between IABP support after PCI and IABP-assisted PCI (59.2% versus 18.1%, respectively, p = 0.006). Among the entire study population, no reinfections or repeat PCI were reported. There was no significant difference between these two groups in the rates of emergency bypass surgery and cerebral vascular events. Practical Implication: This research study on in-hospital mortality among patients with acute coronary syndrome and cardiogenic shock treated with PCI and IABP has practical implications that benefit the community. It enhances patient outcomes, informs clinical decision-making, contributes to treatment guidelines and protocols, facilitates healthcare resource allocation, and inspires future research and innovation. Ultimately, the study aims to improve the quality of care provided to patients in this specific population, leading to reduced mortality rates and improved patient well-being Conclusion: This study concluded that PCI assisted by IABP results in a better outcome for patients with cardiogenic shock complicating acute myocardial infarction and a lower mortality rate compared to IABP after PCI. Keywords: In-hospital mortality, percutaneous coronary intervention, intra-aortic balloon pump.

Objective: The objective of this research is to assess the efficacy of left main coronary artery (LMCA) revascularization and to document the outcomes for patients who underwent this procedure. Methodology: The National Institute of Cardiovascular Diseases (NICVD) in Karachi conducted a cross-sectional study from January 2018 to December 2019 and discovered that participants had a decreased risk of developing heart disease. All patients aged 18 and above who received percutaneous LMCA revascularization at the study location were considered for inclusion. We evaluated patient outcomes in the hospital by charting and doing telephonic follow-ups for one year. Regarding quantitative variables, the results were expressed as means and standard deviations, and concerning qualitative variables, as percentages. Results: The study center treated 95 patients with LM PCI during the study period. 68 (71.5%) of the people who had LM PCI had unprotected LM. LM PCI was most commonly performed on 44 patients (46.3%) presenting with unstable angina. Ninety-one (95.7%) patients required PCI due to native LM illness, while four patients (4.2%) underwent LM PCI as a rescue treatment. There were 41.7 ± 26.9 months of follow-up on average. Participants were followed up on average for 41.7 ±26.9 months, and they were admitted to the hospital on average for 4.45 ±3.2 days. The death rate in the hospital was 12.6%, and this was followed by the mortality rate at 1 year and a mean follow-up of 7.5% and 6.7%, respectively. Conclusion: Hemodynamically unstable patients, or those who cannot have bypass surgery for various reasons, have a successful therapy option in Pakistan: LM percutaneous coronary intervention. It may be necessary for the future to conduct prospective studies to evaluate whether PCI can be used to treat LM lesions when compared with existing treatments. Keywords: Percutaneous coronary, Intervention Coronary artery disease, Intravascular ultrasound, Left main coronary artery.

Background: Coronary slow flow phenomenon (CSFP) and coronary no-reflow phenomenon (CNP) have the potential to raise the risk of severe cardiovascular adverse events (MACE). Objectives: This study's goal was to evaluate and contrast the clinical outcomes after a year for CNP and CSFP patients who received PCI for a non-ST elevation myocardial infarction (NSTEMI). Methods: In this research, 95 patients had NSTEMI and had PCI within 24 hours after symptoms started. An angiographic characteristic of the infarct-related artery's TIMI flow was used to divide patients into two groups: the CSP group (n=85) and the CNP group (n=10). Patients were tracked for a full year. To be statistically significant, the p-value needed to be <0.05. Results: There were 95 patients with NSTEMI included in this research (66 males; mean age: 62.71±13.70). CNP was seen in 10.5% (n = 10) and CSFP in 89.4% (n = 85) of NSTEMI patients, respectively. we provide the results of our demographic analysis. Conclusion: When comparing CNP and CSFP patients with NSTEMI, the clinical results and risk of stroke are worse for CNP individuals. Keywords: Coronary no-reflow Phenomenon, Slow-Flow Phenomenon, non-ST-elevation myocardial infarction.

Background: Treatment delay is considered to be one of the important predictors of survival in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). We investigated the impact of early successful PPCI for STEMI patients on left ventricular ejection fraction. Methodology: This prospective study was carried out on 50 patients having STEMI undergoing PPCI in NICVD Karachi. Patients were divided into two groups, Group A, early presenter, patients received treatment with PPCI within six hours of the onset of symptoms, and group B, late presenter, patients received treatment after six hours up to twenty-four hours of the onset of symptoms. Results: Group A patients showed promising results, having achieved TIMI grade III flow in 100%, whereas 85% of patients achieved TIMI grade III flow in group B (P = 0.02). There was a statistical difference between the two groups. Using Independent sample T-Test Group A patients showed improved LVEF as compared to Group B (at presentation 45.49±3.99% vs. 35.25±3.85%; P = 0.001 and at 3 months follow up 55.66±0.92% vs. 45.75±1.44%; P = 0.001). Conclusion: Early PPCI treatment of STEMI patients can lead to improved TIMI grade flow and LVEF. Efforts must be made to shorten the delay in reperfusion therapy.

Objective: The purpose of this study was to compare the HRQoL of patients who had complete revascularization at the time of the first admission to those who underwent revascularization of the infarct artery alone using the EQ-5D (European quality of life-5 dimensions) self-report questionnaire. Background: The effect of revascularization procedures on health-related quality of life (HRQoL) in patients with multivessel disease who undergo primary percutaneous coronary intervention is the subject of controversy (P-PCI). Methods and Results: There was a significant difference between individuals with STEMI who received revascularization of the infarct-related artery alone and those who got total revascularization. we divided the group by the extent of complete revascularization (n=147) or the extent of IRA-only revascularization (n = 153) during the index admission Mobility, self-care, routine activity, pain or discomfort, anxiety, and sadness were all evaluated using the EQ-5D scale. The prevalence of heart failure and the gender of patients were different at baseline. Patients who had full revascularizations had lower mean ±SD (EQ-VAS and EQ-5D) utility ratings than those who had infarct artery revascularizations alone after 2 years of follow-up. (70.00 (±19.9) vs. 51.04 (±17.8), P < 0.04, and 0.71 (±0.03) vs0.61 (±0.03), P<0.005, respectively). Conclusion: Complete revascularization produced clinically significant increases in quality of life when compared to treating just the IRA at 24 months. Keywords: Complete Revascularization, Infarct-related artery, Primary percutaneous coronary angioplasty, ST-segment elevation.

Objectives: The aim of this pilot study was the first-in-man evaluation of the safety, feasibility, deliverability, and efficiency of the newly developed REJUVENATE® bare metal stent system in coronary artery disease. Methodology: Current study was a pilot non-randomized, multi-centric and prospective study which was intended to study the safety of the REJUVENATE® bare metal stent in Pakistani population over 10 months. Study endpoints included target vessel related myocardial infarction, stent thrombosis, in-stent restenosis, stroke and death. The diameter of the target lesions selected was between 3-4mm with length no more than 22mm. Only one BMS was implanted per patient. These patients had well defined regular clinical follow-ups and CT scan coronary angiography at the end of 10 months. Results: 20 patients suffering from coronary artery disease (CAD) including15 male subjects and 5 female subjects were enrolled in this study and were treated with REJUVENATE® BMS. 65% patients were hypertensive, 25% diabetics and 25% were active smokers. Out of the 20 stents implanted, 14 stents were implanted in the right coronary artery and 6 were implanted in the left circumflex artery. During this 10-month study period there was 10.65% of cases in which late lumen loss (lumen stenosis <70%) was observed, however no cases of in stent restenosis and stent thrombosis were observed. There was no target vessel related myocardial infarction or stroke as well. One patient died of pneumonia during the follow up period. Conclusion: The current study demonstrated the deliverability and clinical safety of REJUVENATE® bare metal stent over a period of 10 months.

BACKGROUND Even though percutaneous coronary intervention (PCI) improved the survival of patients with acute myocardial infarction, still multivessel coronary artery disease remains an important factor burdening prognosis and it is being associated with a worse prognosis compared to single-vessel disease (SVD). AIM To compare the clinical profile and outcomes after the primary PCI in young patients with SVD vs multivessel disease (MVD). METHODS The retrospective cohort of patients were divided into two groups: SVD and MVD group. The study population consisted of both male and female young (≤ 45 years) patients presented with ST-elevation myocardial infarction (STEMI) at the National Institute of Cardiovascular Disease, Karachi, Pakistan and undergone primary PCI from 1st July 2017 to 31st March 2018. Pre and post-procedure management of the patients was as per the guidelines and institutional protocols. RESULTS A total of 571 patients with STEMI, ≤ 45 years were stratified into two groups by the number of vessels involved, 342 (59.9%) with SVD and 229 (40.1%) with MVD. The average age of these patients was 39.04 ± 4.86 years. A lower prevalence of hypertension and diabetes was observed in SVD as compare to MVD group (25.1% vs 38%, P < 0.01; 11.7% vs 27.5%, P < 0.001) respectively. While, smoking was more prevalent among the SVD group as compare to MVD group (36.3% vs 28.4%, P = 0.05). The high-C Lesion was observed in a significantly higher number of younger patients with MVD as compared to SVD group (48.8% vs 39.2%, P = 0.021). Post-procedure thrombolysis in myocardial infarction flow grade was found to be not associated with the number of diseased vessels with a P value of 0.426 and thrombolysis in myocardial infarction flow grade III was observed in 98% vs 96.5% of the patients is SVD vs MVD group. CONCLUSION The MVD comprised of around 40% of the young patients presented with STEMI. Also, this study shows that diabetes and hypertension have a certain role in the pathogenesis of multivessel diseases, therefore, preventive measures for diabetes and hypertension can be effective strategies in reducing the burden of premature STEMI.

Background In the current coronavirus disease-2019 (COVID-19) pandemic, the pattern of hospital admissions for acute ST-elevation myocardial infarction (STEMI) is changing, and increased mortality and morbidity is being noted in these patients. Cardiac manifestations of COVID-19 are complex and include STEMI, myocarditis, myocardial injury, and cardiomyopathy. The objective of our study was to compare the data of patients with STEMI presenting in COVID-19 versus the non-COVID-19 era. Methods We analyzed the clinical and angiographic characteristics of STEMI patients undergoing primary percutaneous coronary intervention (PCI) at our center. The primary outcome variables were admission rate for STEMI, mean total ischemic time (TIT), coronary artery disease burden, mean ejection fraction, and in-hospital mortality for three defined groups. Group A consisted of patients who underwent primary PCI from March through April 2020. Group B included patients who underwent primary PCI from January to February 2020. Group C consisted of patients who underwent primary PCI from March to April 2019. We then compared the data among the three groups and calculated any significant p-value (p<.001). Results In Group A, 1139 patients were admitted for primary PCI. The mean admission rate was 18.6 ± 4.36 admissions per day. There were 1535 patients in Group B and an admission rate of 26.01 ± 4.90 (p<.001 compared to Group A). In Group C, there were 1537 patients and an admission rate of 24.8 ± 4.55 (p<.001, compared to Group A). The mean TIT was 429.25±272.16 minutes for Group A, 359.78±148.04 minutes for Group B, and 346.75±207.31 minutes for Group C (p<.001). A higher mortality rate was noted in Group A (COVID-19 era) versus Group C (non-COVID-19 era; p<.001). Conclusions A lower admission rate, higher TIT, and higher mortality rates were noted in patients with acute STEMI during the COVID-19 pandemic compared to the pre-COVID era. During the COVID-19 pandemic, physicians should bear in mind that patients with STEMI have increased mortality and morbidity. Where possible, efforts should be made for timely management of these critical patients to decrease mortality.

Background: This study was conducted with the aim of providing a quantitative appraisal of clinical outcomes of trans-radial access for primary percutaneous coronary interventions (PCI) in patients with ST-segment evaluation myocardial infarction (STEMI). Methods: In this study, we compared two propensity-matched cohorts of patients who underwent primary PCI via trans-radial (TRA) and trans-femoral access (TFA) in a 1:1 ratio. The profile of two cohorts was matched for gender, age, and body mass index, diabetes, hypertension, family history, and smoking. The outcomes of primary PCI were compared for the two cohorts which included all-cause in-hospital mortality, heart failure, re-infarction, cardiogenic shock, bleeding, transfusion, cerebrovascular accident, and dialysis. Results: This analysis was performed on a total of 2316 patients with 1158 patients each in the TRA and TFA group. We observed significantly lower rates of mortality, 0.8% (9) vs. 3.5% (41); p < 0.001 and bleeding, 0.5% (6) vs.1.6% (19); p = 0.009 with shorter hospital stay, 1.61 +/- 1.39 vs. 1.98 +/- 1.5 days, in trans-radial vs. trans-femoral. However, both fluoroscopic time and contrast volume were significantly higher in the TRA as compared to TFA group 15.57 +/- 8.16 vs. 12.79 +/- 7.82 min; p < 0.001 and 143.22 +/- 45.33 vs. 133.78 +/- 45.97; p < 0.001 respectively. Conclusions: Compared with TFA access, TRA for primary PCI is safe for patients with STEMI, it was found to be associated with a significant reduction in in-hospital mortality and bleeding complications. (C) 2020 Cardiological Society of India. Published by Elsevier B.V.

Background The aim of this study was to evaluate the safety and efficacy of transcatheter aortic valve implantation (TAVI) program in a Tertiary care hospital in Karachi, Pakistan. Methodology This study was conducted by interventional cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi from July 2015 to February 2020. All patients of severe aortic stenosis (AS) who underwent TAVI were included. Baseline characteristics, in-hospital course and one-month follow-up data were collected. Results This study included 100 consecutive patients with severe AS undergoing TAVI. Sixty-three (63.0%) patients were males and the mean age was 67.38 ± 10.73 years. Eighty-five (85%) patients were in the New York Heart Association (NYHA) class III-IV. Aortic valve mean gradient was 51.33±10.47 mmHg and 50% of patients had bicuspid aortic valves. Core valve was implanted in 86 (86%) and evolute-R aortic valve was implanted in 14 (14%) patients. TAVI was successfully done in 94% of patients. Post-deployment aortic valve mean gradient was 5.33±4.13 mmHg. Major vascular access site complications were noted in 14% and atrioventricular (AV) blocks were seen in 22% of cases. There was a significant difference in symptoms of patients before and after the procedure. Overall, eight (8%) patients expired during hospital stay. At one-month follow-up, 76% of patients were found to have no limitation of physical activities. Conclusions Results of this study showed that TAVI is a safe procedure in these high-risk patients and is an alternative to surgery for AS patients in the region.

Background ST elevation myocardial infarction (STEMI) is classically characterized by total occlusion of the culprit coronary artery. However during primary percutaneous coronary intervention (PCI) thrombolysis in myocardial infarction (TIMI) 0 flow is not observed in all patients' culprit arteries in angiographic views. This study was conducted to find out the frequency of TIMI flow in acute STEMI patients in view of the above concept. The aim of this study was to evaluate the frequency of pre-procedural TIMI III flow in those patients who underwent primary PCI for acute STEMI in a public sector hospital in Karachi, Pakistan. Methodology This study is an audit of already saved data in the catheterization laboratory of the National Institute of Cardiovascular Diseases (NICVD), Karachi, that was collected prospectively from January 2016 to December 2018. These data were collected after taking consent from those patients who presented to hospital within 12 hours of symptoms and underwent primary PCI. Data were entered and analyzed on Statistical Package for the Social Sciences (SPSS) version 19 (IBM Corp., Armonk, NY, USA). Results A total of 8018 patients were included in this study who presented with STEMI and underwent primary PCI. Out of them 80.9% were males. Hypertension was the leading risk factor in 54.1% (4340) of patients. TIMI III flow was present in 11.4% of patients before primary PCI, while TIMI 0, I and II flow were present in 57.1%, 15.1%, and 16.3% of patients respectively (p<0.001). Fourteen percent of patients with TIMI III flow were of age group 51 to 60 years. Among those who had TIMI III flow, 11.2% were those with door to balloon time of <90 minutes. In 11% of cases, left anterior descending (LAD) artery had TIMI III flow as compared to other vessels (p<0.001). The length of the lesion was significantly smaller in patients who had TIMI III flow compared to those who had TIMI 0-II flow. Conclusions This study revealed that not all patients with acute STEMI had totally occluded culprit coronary artery but some of them had angiographic TIMI I-III flow in the infarct-related artery. Further studies are needed to find the reason for re-establishment of flow in the culprit vessel in STEMI patients before PCI.

BACKGROUNDMulti-vessel disease is associated with higher mortality rates in ST-Elevation Myocardial Infarction (STEMI) patients, which may further alter clinical course and decision making. Hence, the purpose of this study is to determine prevalence, in hospital and early after discharge (up to 30 days) outcome of patients with multi-vessel disease as compared to single vessel disease presenting with acute STEMI undergoing Primary PCI.METHODSThis study includes 282 consecutive selected patients, presented in emergency department with acute STEMI; undergo primary percutaneous coronary intervention (PCI) at Catheterization Laboratory of National Institute of Cardiovascular Diseases (NICVD), Karachi Pakistan during the study period of 17th December 2016 to 16th June 2017. Demographic characteristics, clinical history, post procedural complications, and short term adverse clinical events in patients with SVD and MVD were assessed and compared using z-test, t-test, and Fisher's Exact test..RESULTSComparing the patients with single vessel disease, multi-vessel disease patients have worse post procedural outcomes, increased overall complications, length of hospital stay, higher referral for CABG, and in-hospital mortality. On follow up relatively higher, but not statistically significant, patient with MVD developed recurrence of symptoms and got re-admission.CONCLUSIONSMulti-vessel disease in patients presenting for primary PCI is the direct indicative of significantly higher post procedure complications, mortality, morbidity, and prolonged hospitalization. Also, risk of recurrence of symptoms and re-admission remains high in patients with multi-vessel disease..

OBJECTIVES:In the present study, we analysed the incidence of no-reflow phenomenon, its clinical and procedural predictors, and associated in-hospital outcomes for the patients undergoing primary percutaneous coronary intervention (PCI). BACKGROUND:No-reflow phenomenon after primary PCI is a procedural complication associated with adverse post-procedure outcomes. METHODS:Data for this study were extracted from global registry, NCDR®, the site of National Institute of Cardiovascular Disease (NICVD), Karachi from July 2017 to March 2018. The demographic, clinical, and procedural characteristics, and in-hospital outcomes were analysed for the patients with and without no-reflow after primary PCI. RESULTS:Of total of 3255 patients, no-reflow phenomenon was found in 132 (4.1%) patients and it was associated with significantly higher in-hospitality mortality (6.8% vs. 2.9%; p = 0.01), cerebrovascular accident (1.5% vs. 0%; p < 0.001), post procedure bleeding (2.3% vs. 0.5%; p = 0.009), and cardiogenic shock (3.8% vs. 1.2%; p = 0.011). The multivariate analysis showed advanced age [odds ratio = 1.63, 95% confidence interval 1.09-2.44, p = 0.018], diabetes [1.66, 1.14-2.42, p = 0.009], prior history of CABG [8.70, 1.45-52.04, p = 0.018], low pre-procedure TIMI flow grade [2.04, 1.3-3.21, p = 0.002], longer length of target lesion [1.51, 1.06-2.16, p = 0.023], and 10 fold raised troponin I [1.55, 1.08-2.23, p = 0.018] were the independent predictors of no-reflow. CONCLUSIONS:In this selected group of patients, the no-reflow phenomenon after primary percutaneous coronary intervention is not that uncommon. It is associated with an increased risk of adverse post-procedure hospital course including mortality. Pathophysiology of the no-reflow phenomenon is complex and opaque, however, it can be predicted based on certain clinical and procedural characteristics.

https://e-jcvi.org One of the complications of percutaneous coronary intervention is stent dislodgement that can lead to dire consequences either in the form of surgery or death.1) Most of the time, dislodgment of the stent is identified in fluoroscopy. In some cases, it is missed and can be identified in cardiac computed tomography.2) We report a 42-year-old male, who presented with two hours history of typical chest pain and profuse sweating. On examination pulse was 54 bpm with blood pressure of 110/80 mmHg and clear chest on auscultation. Blood tests were normal except for the Troponin I which was elevated. 12 lead electrocardiogram showed ST segment elevation in II, II, aVF with reciprocals in lead I and aVL suggestive of acute inferior wall myocardial infarction. Coronary angiography showed totally occluded proximal right coronary artery (RCA) and no significant lesion in left coronary artery. The patient underwent primary percutaneous coronary intervention of RCA. During the procedure he developed catheter-induced dissection for which 3.5 × 30 mm resolute stent was deployed. The actual lesion was distal to the stent. Another stent of 3.5 × 33 mm resolute stent was tried to cross through the stent and was presumed that stent has been deployed distally. On careful examination stent images in right coronary artery was not visualized. A search for stent dislodgement was done under fluoroscopy. After failure to detect the stent, patient shifted to CT room for CT image acquisition, which showed portion of stent in the RCA with its unfolded stents flipping in the aortic root. The stent was retrieved with a snare and 3.5 × 33 mm resolute stent was deployed distally. Coronary angiographic imaging after deployment of stent showed TIMI 3 flow with no dissection distal to stent (Figure 1). The hospital course was uneventful and patient was discharged with good condition. J Cardiovasc Imaging. 2019 Jan;27(1):68-69 https://doi.org/10.4250/jcvi.2019.27.e2 pISSN 2586-7210·eISSN 2586-7296

BACKGROUND:Smoking is a well-established cardiac risk factor there is dearth of Local data regarding clinical and angiographic characteristics of smoker patients. OBJECTIVES:This study was planned to assess the differences in the clinical characteristics, angiographic characteristics, and in-hospital outcomes of smokers and nonsmokers after primary percutaneous coronary intervention at a tertiary care hospital in Karachi, Pakistan. METHODS:We included patients between 40 and 80 years of age diagnosed with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention from July 1, 2017, to March 31, 2018. Clinical and angiographic characteristics and in-hospital outcomes were obtained from the cases submitted to the National Cardiovascular Data Registry's CathPCI (Catheterization-Percutaneous Coronary Intervention) Registry from our site. RESULTS:A total of 3,255 patients were included in this study. Smokers consist of 25.1% (817) of the total sample. A high majority of smokers were male, 98.8% (807), and smokers were relatively younger as compared to nonsmokers with a mean age of 52.89 ± 10.59 versus 55.98 ± 11.24 years; p < 0.001. Smokers had higher post-procedure TIMI (Thrombolysis In Myocardial Infarction) flow grade III: 97.8% (794) versus 95.53% (2,329); p = 0.037, and they had a relatively low mortality rate: 2.69% (22) versus 3.16% (77); p = 0.502. CONCLUSIONS:Smokers were predominantly male and around 3 years younger than nonsmokers. Diabetes mellitus and hypertension were less common among smokers and single-vessel disease was the more common angiographic finding for smokers as compared to 3-vessel disease for nonsmokers. No statistically significant differences in in-hospital outcomes were observed. ST-segment elevation myocardial infarction in smokers despite younger age and the low atherosclerotic risk profile, in our region, emphasize the need for nicotine addiction management and smoking cessation campaigns at large and for pre-discharge counseling.

Introduction Coexistence of atrial fibrillation (AF) in patients with heart failure (HF) is a common phenomenon associated with poor prognosis. Therefore, this study was designed with an aim to estimate the different risk factors of atrial fibrillation (AF) in patients with HF. Methods In this study, patients of either gender, 18 to 80 years of age, and with echocardiographic confirmation of HF presenting at the adult cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan were consecutively included. Patients diagnosed with chronic obstructive airway diseases, pneumonia, or pericarditis, and patients diagnosed with existing AF were excluded from the study. Data regarding demographic and clinical risk factors of AF were obtained using a structural proforma. Results Out of 150 patients, 59.3% (89) were females, and the mean age was 50 ± 16 years. A majority of the patients, 55.3% (83), had a history of rheumatic heart diseases (RHD) and 22.7 (34) percent had a history of transient ischemic attack (TIA) or cerebrovascular accident (CVA). On echocardiography, 28.0% (42) of the patients had right ventricular (RV) dysfunction, and the clot was seen in 28.0% (42) of the patients. Mitral stenosis (MS) and mitral regurgitation (MR) were observed in 34.5% (61) and 29.3% (52) of the patients, respectively. Conclusion We observed that the adult population with HF tends to have multiple risk factors of AF. More coordinated efforts are needed by the healthcare professionals to understand and manage these coupled conditions.

Introduction The common femoral artery (CFA) is the optimal access point for femoral arterial puncture. A higher or lower puncture can result in various vascular complications and by the proper definition of the femoral arterial bifurcation level and the optimal puncture point such complications can potentially be avoided. In the literature, little data is available about the frequency of femoral artery bifurcation and the relationship between the bifurcation level of one artery and its contralateral counterpart in our part of the world. Methods We performed a prospective study from April 2016 to September 2016 to define the frequency of bifurcation of the CFA in relation to the femoral head and the relationship between bilateral CFA bifurcations, with bilateral femoral angiography on 579 patients undergoing routine coronary angiography. Results The frequency of normal/low, high, and very high femoral bifurcations was 66%, 26%, and 8%, respectively. There was no significant difference in the bifurcation of CFA between the two sides (p = 0.51). A specific bifurcation level on one side significantly increased the likelihood of the same bifurcation level on the contralateral side (odds ratio (OR) = 151.86 (51.39-448.77)). A multivariable logistic regression analysis revealed age, race, gender, height and weight, body surface area (BSA), and body mass index (BMI) were not predictive of any specific bifurcation level on either side. Conclusions The majority (two-thirds) of the individuals in the study population were with normal/low femoral bifurcation with no significant difference in bifurcation level on either side.

Objective: To know regression of ECG changes after successful percutaneous mitral commissurotomy ( PTMC) for severe isolated mitral stenosis patients. Methodology : This cross sectional study was conducted from 1st Feburary 2016 to 31 August 2016 (06 months) in National Institute of Cardiovascular Diseases, Karachi - Pakistan. All consecutive patients admitted for PTMC for severe isolated mitral stenosis were subjected to detailed transthoracic echocardiogram (TTE) and 12 leads ECG before and after procedure as per protocol. All the data were analyzed by SPSS Version 19.0 Results: Among total of 99 study population, females were 65(65.7%). Mean age was 27.44 +/- 6.26 years. Standard 12 lead ECG showed P wave amplitude of 0.26 +/- 0.0491 mV pre PTMC versus 0.24 +/- 0.036 mV post PTMC (p < 0.001). P wave duration in V1/V2 (greater of these two chest leads) was 114.32 msec +/- 11.94 msec (80-140msec) and 108.64 msec +/- 14.55 (80-140msec) pre and post PTMC respectively (p < 0.001). R wave amplitude in V1/V2 (greater of the two) 0.2879 +/- .2031 mV vs. 0.2313 +/- .1475 mV pre and post PTMC respectively (p < 0.001). Axis of the heart was 88.28 +/- 19.51 degree (45-120) pre PTMC vs. 84.34 +/- 19.79 degrees (30-120) post PTMC respectively. RV hypertrophy as demonstrated by R wave in V1 plus S wave in V5 was 0.4830 +/- .2239 millivolt vs. 0.3980 +/- .1823 millivolt (p < 0.001) pre PTMC&post PTMC respectively. Conclusion: Successful PTMC procedure causes significant regression of quantitative ECG changes in isolated mitral stenosis patients in mid-term follow up.

Objective: To know the regression of right ventricular pressure after successful percutaneous transluminalmitral commissurotomy (PTMC) in patients with severe isolated mitral stenosis. Methods: This descriptive study was performed in inpatient and outpatient department of National Institute of Cardiovascular Disease from 1st February 2016 to 31st August 2016. Echocardiography of all patients with successful PTMC were recorded 24 hours and 06 months following PTMC to see for Regression of right ventricular pressure along with other baseline echocardiographic parameters. Results: A total of 99 patients with severe isolated mitral stenosis who had undergone successful PTMC were studied. Females were 65(65.7%) and males 34(34.3%). Mean age was 27.44±6.26 years. TTE performed before and after PTMC showed significant difference in mean mitral valve area (0.89cm ±0.089cm2 vs. 1.68±0.128 cm2, p valve <0.001) and mean left atrial diameter (4.66± .82cm vs. 4.46± 0.65cm). Mean mitral valve gradient pre PTMC was significantly higher (16.38±2.51 mm of Hg) than that of post PTMC 24 hours (4.75±1.31 mm of Hg) and Post PTMC 06 months (5.22±1.21 mm of Hg), p valve <0.001. Mean right ventricular systolic pressure (RVSP) pre PTMC was significantly higher 62.3±10.91 mm of Hg than that of post PTMC 24 hour’s 57.51±9.67 mm of Hg and post PTMC 06 moths 46.49±7.8mm of Hg, p value 0.001. Mean LVEF 50.14± 5.82. Conclusion: There was a significant regression of right ventricular pressure following successful PTMC in mid-term (06 months) follow up of severe isolated mitral stenosis patients.