Amit Joshi ¹, S. V. Patted ¹, P. C. Halkati ¹, Sameer Ambar ¹

Affiliations
1 KLES Dr. Prabhakar Kore Hospital & MRC, Department of Cardiology, Jawaharlal Nehru Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, IN

Abstract

Background and Objectives: Intra-Aortic Balloon Pump (IABP) is device developed to augment coronary blood flow and improve systemic blood pressure in patients with circulatory failure. This study was undertaken to analyze morbidity and mortality benefit of IABP counterpulsation in patients with Acute Myocardial Infarction (AMI) Methodology: This cross-sectional study done for three years in the Department of Cardiology of a tertiary care centre in North Karnataka from June 2009 to June 2012. Prior to the commencement of the study, ethical clearance was obtained from Human Ethics Committee. A total of 82 consecutive patients presenting with cardiogenic shock were included in the study. The patients satisfying selection criteria were informed in detail about the nature of the study and a written informed consent was obtained. The patients underwent electrocardiography and echocardiography. Based on the findings the indication for IABP was determined. Results: Majority of the patients were males (85.4%) and the commonest age group was 51 to 60 years (40.2%) with the mean age of 57.73 ± 9.41 years. Most common Electrocardiogram (ECG) presentation was Anterior Wall Myocardial Infarction (AWMI) (40.2%). The commonest indication for placement of an IABP was Left Ventricular (LV) dysfunction (47.6%) and mean duration of IABP was 4 ± 1 days. Diagnostic catheterization was performed in 55 (67.1%) patients. Among them, 40 (72.7%) underwent Percutaneous Transluminal Coronary Angioplasty (PTCA) and 15 (27.3%) underwent surgery. Of the 82 patients, major IABP related complications occurred in six (7.3%) patients. The in-hospital mortality rate was 43.9% and 56.1% of the patients improved. Of the 46 patients who improved, majority (78.2%) had undergone revascularization while of the 27 patients who expired, 47.2% did not had revascularization (p=0.015). The outcome in patients who had undergone either PTCA or surgery was significantly favourable resulting in improvement (p<0.050). Conclusion and Interpretation: IABP counterpulsation can be successfully employed for a wide variety of conditions in the AMI setting, providing significant haemodynamic support with rare major complications in a high-risk patient population.

Keywords

Acute Myocardial Infarction, Haemodynamic Support, Intra-aortic Balloon Pump, ST Elevation Myocardial Infarction

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Ravi Solbannavar ¹, S. V. Patted ¹, Prabhu Halkatti ¹, Rajat Aurora ¹

Affiliations
1 Department of Cardiology, Jawaharlal Nehru Medical College, Nehru Nagar, Belgaum-590 010, Karnataka, IN

Abstract

Background and Objectives: Prognostic value of incidentally discovered RBBB has important implications for cardiovascular risk assessment. This research intended to describe the prevalence and severity of CAD in patients presenting with chest pain and RBBB by correlating clinical and angiographic findings. Methodology: This one cross-sectional study was conducted in the Department of Cardiology of a tertiary care centre in North Karnataka from January 2012 to December 2012. A total of 50 patients presenting with chest pain and RBBB (both complete and incomplete) on ECG were included. The patients underwent chest X-ray, ECG and 2D echocardiography. Coronary angiography was done in the eligible patients and the findings with regard to LAD, ramus, LCX, OM and RCA were noted. Results: Majority of the patients were males (88%) and the commonest age group was more than 60 years (48%). History of hypertension, diabetes and hyperlipidemia were noted in 56%, 36% and 26% respectively. Personal history of smoking was reported by 52% while tobacco chewing and alcohol consumption was reported by 22% and 30%. Myocardial infarction was noted 48% of the patients and anterior wall MI was present in 62.5%. Abnormal coronary angiographic findings were noted in 82% and 48% of the patients had multivessel disease with involvement of proximal LAD (54%). Statistically significant association was found between coronary artery disease and male sex, age more than 60 years, comorbid conditions, habits, hypertriglyceridemia, low HDL, troponin I. Conclusion and interpretation: There is high rate of CAD in patients presenting with chest pain and RBBB. Angiography may be recommended among these patients to rule out the presence of CAD so as to advocate the effective management strategy.

Keywords

Aoronary Artery Disease, Coronary Angiography, Right Bundle Branch Block.

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Sandeep ¹, S. V. Patted ¹, Ranjan Modi ¹

Affiliations
1 Department of Cardiology, Jawaharlal Nehru Medical College, Nehru Nagar, Belgaum-590010 Karnataka, IN

Abstract

Objectives: Stent length is an important predictor of adverse events after PCI. The study was aimed to evaluate the clinical outcome of long stent length. Methodology: The present one year prospective study included 660 consecutive patients who underwent long segment elective coronary artery stenting from April 2012 and March 2013. The patients were divided into three cohorts depending upon the stent length 24-28 mm, 29-32 mm and more than 32 mm. Study endpoint was Major Adverse Cardiac Events (MACE) including cardiac death, myocardial infarction, repeat revascularization and stent thrombosis. Results: The commonest age group was 51 to 60 years (45.91%) of the 660 patients, 211 (31.97%) had stent length between 24 to 28 mm, 198 (30%) had 29 to 32 mm and 251 (38.03%) had > 32 mm. Risk factors including hypertension, diabetes mellitus, smoking, dislipidemia, obesity, family history and cerebrovascular accident were comparable in patients with different stent lengths (p>0.050). Significantly higher number of patients with 32 mm stent length had overlapping, dissection and direct stenting (p<0.050). Overall MACE was significantly high in patients with stent length >32 mm (p=0.045) but no statistically significant difference was observed on comparison of individual variables (p>0.050). Also comparable outcomes were noted in patients with diabetes mellitus and without diabetes mellitus (p>0.050). Conclusion and Interpretation: Use of more than 32mm Drug Eluting Stent (DES) for the treatment of long lesions results in overall high MACE rate.

Keywords

Coronary Artery Disease, Drug-Eluting Stents, Major Adverse Cardiac Events (MACE), Percutaneous Coronary Intervention, Stent Length.

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