Search

Objectives: The new generation antiplatelets are generally recommended by the current US and European guidelines. This article aimed to address the efficacy and safety of using ticagrelor in patients with ST-elevated acute coronary syndromes.Methods: This was a prospective observational study on 120 patients admitted to the Cardiology Care Unit of Assiut University Hospital with ST-segment elevation acute coronary syndrome, who were admitted for urgent revascularization and received aspirin and the P2Y12 antagonist ticagrelor. The patients were followed for three months between May 2018 and September 2019. The primary efficacy end point was the incidence of major adverse cardiovascular events (MACE).Results: At three months, the primary efficacy endpoint, a composite of cardiovascular death, myocardial infarction, or stroke - occurred in 11/120 (9.2%) patients. The primary safety endpoint, the incidence of major bleeding, was observed in two patients (1.7%) with no fatal bleedings. Minor and minimal bleeding occurred in 2.5% and 20.8% of patients, respectively. Other efficacy endpoints were myocardial infarction 4.2% and stent thrombosis (1.7%). Severe dyspnea found in 5.0% of patients and led to 1.7% ticagrelor discontinuation. Multivariate regression analysis revealed no association between bleeding and patients’ age, sex nor IV administration of glycoprotein IIb/IIIa inhibitor. Conclusion: The MACE with ticagrelor was higher than previously reported in most studies. Dyspnea rate was higher and more pronounced than bleeding rate. The majority of bleeding cases were minimal with no fatal major bleeding and no bleeding led to comorbidity.

Background: One of the risk factors of congestive heart failure that still under investigations is hyperuricemia. It's still debatable whether it's an independent risk factor or it's just a consequence of other disorders associated with cardiovascular diseases like hypertension, diabetes and dyslipidemia. Objective: The aim of our study is to elucidate whether in patients with heart failure serum uric acid level correlated with left ventricular ejection fraction supporting the possibility that the detection of progressive hyperuricemia in these patients may be an indicator of deteriorating cardiac function. Methods: We conducted a prospective study that included 124 studied patients and 26 apparently healthy persons at Coronary care unit and Internal Medicine Department at Sohag University Hospitals. All studied populations were classified into four groups; v Group "I" patients being newly diagnosed heart failure, v Group "II" patients decompensated heart failure on regular treatment, v Group "III" patients decompensated heart failure but stopped their treatment from three months, v Group "IV" control group selected to our study healthy and age-matched subjects from 30 to 70 years old . Then we studied the association between left ventricular ejection fraction, the severity of congestive heart failure and the serum uric acid levels and the well-known conventional risk factor that include age, sex, BMI, positive family history, smoking, hypertension, diabetes and dyslipidemia then through logistic regression analysis we tried to identify the independent predictors of coronary artery diseases. Results: The mean finding in our study is the significant higher mean ± SD serum uric acid levels in patients with congestive heart failure (8.43±2.95) versus apparently healthy persons (5.55±1.48) with "P value = .02". When we adjusted the serum uric acid with others significant factors in the univariate analysis which were age, gender and smoking, serum uric acid was an independent risk factor "P value = .04". Another interesting finding is significant correlation between serum uric acid level and the severity of congestive heart failure "P value

Background/objectives Systemic sclerosis (SSc) is an autoimmune disease associated with immune abnormalities and widespread vascular lesions, including increased intimal and medial thickness. These changes may be reflected in early atherosclerosis and cardiovascular risks. We aimed in this study to examine the carotid artery intima-media thickness and MRI brain findings in SSc patients and compared them to a group of normal controls. A relationship between these parameters and clinical measures in SSc was also sought. Methods Seventy-two SSc patients with no central nervous system (CNS) symptoms and 42 healthy controls were included. Clinical and laboratory measures, Medsger’s severity scale, and Doppler ultrasound common carotid artery intima-media thickness (CCA-IMT) were measured. Brain fluid-attenuated inversion recovery (FLAIR)-MRI and diffusion-weighted MRI (DWI) were also done. Results SSc patients had more CCA-IMT, higher CRP, and more brain MRI hyperintense lesions than controls (P

Background Ischemic heart disease represents nearly 1.8 million annual deaths or 20% of all Europe deaths. Reperfusion of the ischemic myocardium decreases infarct's size and improves left ventricular function and clinical outcome in patients with acute myocardial infarction. Objective The study evaluated the outcome of revascularization strategies [primary percutaneous coronary intervention (PPCI) and fibrinolytic] for patients who presented with ST-segment elevation myocardial infarction (STEMI). Patients and methods This is an observational retrospective study that was conducted during March 1, 2018 and August 31, 2018. The study included 232 patients divided into group A (186 patients of them underwent PPCI) and group B (66 patients who received streptokinase). Results In group A, 76.9% of them were males, 33.9% were diabetic, 30.1% were hypertensive, 55.4% were smokers, and 17.7% were addicts, whereas in group B, 77.3% were males, 59.1% were smokers, and 16% were addict, and it was found that diabetes mellitus and hypertension presented in 54.5% and 50 of patients, respectively. Anterior myocardial infarction and KILLIP I presentation were nearly the same in both groups. In-hospital mortality was statistically higher in group B than group A (18.18 vs 8.6%; P = 0.03). Moreover, the mean of ejection fraction by Simpsons during admission at the PPCI patient was found higher in group A than that in the group B (51.20 ± 9.19 vs 46.7 ± 7.61; P = 0.001). Conclusion The implementation of PPCI service is beneficial in patients with STEMI in the form of lower in-hospital mortality and better ejection fraction, so primary PCI is preferred as a strategy in patients with STEMI.

Background: Adipo¬cytokines may play role in pathogenesis of atherosclerosis. The association of the novel adipocytokines, vaspin and visfatin, with atherosclerosis coronary artery disease (CAD) is still obscure. Objectives: To investigate the relationship of vaspin and visfatin adipocytokines with the existence as well as the severity of CAD. Patients and Methods: A total of 87 patients who underwent coronary angiography due to symptoms of stable angina were enrolled in the study. They were divided into two groups; CAD group who have at least single vessel disease and normal group who have normal coronary arteries. The severity of CAD was assessed using coronary angiography by estimation the number of vessels affected and Gensini score. Results: Serum levels of vaspin were significantly lower and inversely, serum levels of visfatin were significantly higher in CAD group than normal (1.51 ± 0.99 μg/L versus 4.54 ± 0.69 μg/L for the former and 22.86 ± 4.68 μg/L versus 13.43 ± 1.1 μg/L for the later; p

Background The treatment of patients with repeated drug-eluting stent–in stent restenosis (DES-ISR) remains a challenge and a burdensome clinical problem. Methods Over a 3-year period, 130 lesions in 123 patients who underwent target lesion revascularization (TLR) for DES restenosis were included in the study. They were classified into two main groups: the first group having first-time DES-ISR ( n =84), and the second group having rerestenosis of DES-treated DES-ISR ( n =39). Further classification according to the treatment strategy yielded four subgroups: balloon angioplasty (BA) in first-time DES-ISR ( n =66), re-DES in the same group ( n =22), BA in rerestenosis of DES-treated DES-ISR ( n =30), and re-DES in the same group ( n =10). Angiographic follow-up was planned at 1year, and clinical follow-up for re-TLR up to 2years later. Results The mean duration of clinical follow-up was 24.8±9.7months. The angiographic follow-up data were obtained for 108 patients (87.8%) at 1year. Among patients treated for first-time DES-ISR, late lumen loss (0.65±0.83mm and 1.02±0.52mm, p =0.02) and binary restenosis rates (25% and 49.1%, p =0.05) were significantly less in those undergoing re-DES compared with BA. This benefit was not evident in patients having rerestenosis of DES-treated DES-ISR. Re-TLR at 2years was significantly less in the re-DES group compared with BA (log rank p =0.038) in first-time DES-ISR patients, while no significant difference (log rank p =0.58) was observed in those having rerestenosis of DES-treated DES-ISR. Conclusion While a strategy of re-DES would be better than BA in first-time DES-ISR, this could not be extrapolated to rerestenosis cases.

The current studyAimed: to identify the impact of implementing an educational nursing program on reducing the level of anxiety and complications among patients undergoing cardiac catheterization.Design: quasi-experimental design was used in this study. Setting: the Current study was conducted atAssiutUniversityHospital in the cardiac catheterization unit.Subjects: 60 adult patients, age between 20 – 65 years, male and female, thirty for each group (study and control). The group of patients who received educational nursing program was considered a study group, while who received a routine care was the control group. Tools: four.Tools: Structure Interview Questionnaire sheet, Hamilton Anxiety Rating Scale, Assessment of complications, & educational nursing program.Results: there was the statistically significant difference between both groups regarding the level of anxiety and incidence of local complications.Conclusion: giving written nursing program for patients more effective in decreasing level of anxiety for patients in the study group than the control group patients.Recommendations: Permanent attendance of a specialized nurse in the cardiac catheterization unit is of great importance to instruct and apply the guidelines of the patients. Simple illustration booklet and pamphlets must be adequate and available for patients with Arabic explanation that helps the patient how to live safely.

Objectives We investigated the incidence of radial anomalies (RA) in patients undergoing transradial (TR) coronary procedure and their impact on procedural outcome in the Egyptian population. Background Radial anomalies (RA) are considered an important factor for procedural failure. Information about anatomical variation is limited in our Egyptian population. Methods We performed a multicentre prospective study in Egypt. A total of 650 consecutive patients undergoing their first TR coronary procedure were recruited from January 2013 till January 2015. By retrograde radial arteriography we assessed the frequency of RA and their impact on procedural outcome. Results 650 consecutive patients were studied, 74% male, mean (SD) age 55 (10) years. The overall incidence of radial artery anomaly was 12.6% (n = 82). 40 (6.2%) patients had a high-bifurcating radial origin, 8 (1.2%) had a full radial loop, 14 (2.1%) had extreme radial artery tortuosity and 20 (3%) had other anomalies such as persistent left subclavian artery and extreme subclavian tortuosity. Overall transradial procedural success was 95%. Procedural failure was more common in patients with anomalous anatomy (39%) than in patients with normal anatomy (0.2%). Procedural failure was highest in patients with radial loop (87.5%), followed by those with subclavian tortuosity (45%), then high radial bifurcation (30%), and severe radial tortuosity (28.5%). 14 (2.1%) vascular complications occurred, all of which were treated conservatively. Conclusion There is a relatively significant presence of radial anomalies, with different degrees of impact on procedural failure rate, in our Egyptian population. Further collaborative studies are recommended to increase our success rates.

Aims To evaluate the safety and efficacy of transradial (TR) percutaneous coronary intervention (PCI) using sheathless hydrophilic-coated guiding catheter (GC) technique compared to the standard TR PCI via 6F GC. Methods and results 67 patients (93 lesions) who underwent TR PCI using sheathless GC technique (6.5 or 7.5 Fr GC) or standard TR PCI (6Fr GC) were included. They were divided into two groups; sheathless TR PCI group (27 patients with 28 lesions) and standard TR PCI group (49 patients with 65 lesions). Baseline clinical, lesion and procedural characteristics were recorded. Radial artery was assessed clinically and using Doppler ultrasound before discharge and after one month. All patients were elective or ad-hoc PCI. The procedure success rate was 100% in both groups. The Sheathless TR PCI patients were older and male sex than standard TR PCI group. ACC/AHA lesion type B2 and C and bifurcation lesions were significantly high at Sheathless TR PCI group. In addition, using IVUS and performing final kissing balloon for bifurcation lesion were significantly common in sheathless TR PCI patients. One patient required rotational atherectomy and another one underwent hugging balloon technique in sheathless TR PCI group but non in the other group. There were no procedure complications or access-site complications in both groups. One patient in sheathless TR PCI group and another in standard TR PCI group (3.7% and 2.1% respectively) experienced radial artery occlusion after the procedure at one-month follow-up without clinical sequelae. Conclusions TR PCI via standard and sheathless hydrophilic-coated GC techniques are effective and safe with high rate of procedural success and low rate of asymptomatic radial artery occlusion. Moreover, TR PCI using sheathless GC technique has the advantage of performing complex intervention requiring large bore catheters that can not be performed via standard TR PCI using 6F GC.