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Objectives: The objective of this study was to determine the frequency of non-compliance to treatment and common precipitating factors in stage C heart failure (HF) patients at a tertiary care cardiac hospital of Karachi, Pakistan. Methodology: This descriptive cross-sectional study was conducted at a tertiary care cardiac center of Karachi, Pakistan. Required number of consecutive patients of either gender between 18 to 75 years of age who were diagnosed with stage C HF were included in this study. Data for the study were collected on a pre-defined proforma consisted of demographic characteristics (gender, age), clinical factors, and precipitants of decompensation of HF (duration of disease, non-compliance to the treatment, infection, arrhythmias, uncontrolled hypertension, and anemia). Results: A total of 114 patients with stage C HF were included. Mean age was 56.7 ± 9.9 years with 34.2% (39) patients above 60 years of age. Male patients were 51.8% (59) of the total sample and median duration of disease was 36 [20 to 60] months. Non-compliance to the HF treatment was observed in 48.2% (55), while among other precipitants, infection was observed in 21.9% (25), arrhythmias in 20.2% (23), uncontrolled hypertension in 13.2% (15), and anemia in 18.4% (21). Conclusion: A significant proportion of stage C HF patients were found to be non-adherent to the prescribed treatment. The most commonly observed triggering factor was infection followed by arrhythmias. Routine practice must include an ongoing assessment of compliance to the treatment and lifestyle modifications among HF patients for the proper counseling of non-complying individuals.

Aim: This study aims to find out the incidence of atrial fibrillation new onset in STEMI patients receiving primary PCI Sample: A total of 169 patients have included after sample size calculation by using WHO sample size calculator version 2.0. Study Design: Descriptive cross-sectional study Place and Duration of Study: This study was conducted at the Department of Interventional Cardiology at the National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan from April 18th, 2020, to October 17, 2020. Methodology: The inclusion criteria set for data collection were as; all the patients undergoing Primary PCI with age between 40 to 80 years, males and females, patients presented with 12 hours of the onset of chest pain with STEMI to enroll in the study. Whereas, patients who had a previous history of any cardiac-related surgery and known AF, also all the patients suffered AF after trial of cardioversion, and those patients who had ejection fraction less than 20% were excluded from the study. Result: The demographic classification showed the mean age of the patients was 55.96±8.9 with a CI of 54.60 to 57.33 years. The mean height of the patients was 167.34±0.56 with CI of 166.2 to 168.46. The mean weight of the patients was 74.84±0.7 with CI of 73.39 to 76.29 kg. The average BMI of all the patients was 26.7±0.28 with CI of 26.2 to 27.33. The analysis of the data revealed that Atrial fibrillation is more common in people who don’t smoke tobacco and are non-diabetic. Diabetic patients are less prone to atrial fibrillation in MI. Conclusion: The prevalence of new-onset of atrial fibrillation was found to be high in elderly age group patients.

Objective: To determine the frequency of smokers and to compare the frequency of smokers among patients with inferior and anterior acute myocardial infarction amongst patients presenting with acute myocardial infarction at a Tertiary Care Hospital. Subjects And Methods: This cross-sectional study was conducted on 226 at the Adult Cardiology Department of the National Institute of Cardiovascular Disease (NICVD), Karachi for six months from 20-07-2019 till 20-01-2020. After obtaining verbal consent, researchers prospectively collected data from the participants. The study included 226 patients who were diagnosed with the appropriate conditions. Frequency and percentages were used to present qualitative data, while mean and standard deviation were used to present quantitative data. To see how to effect modifiers affected the outcome, researchers used stratification to keep track of them. For statistical significance, the post-stratification chi-square test was used. Results: A total of 226 presenting with acute myocardial infarction were included in this study. The mean age in our study was 55.92±10.49 years. Out of 226 patients with acute myocardial infarction, 130 (57.5%) and 96 (42.5) smoked and did not smoke respectively. Comparison of smoking status in patients who had anterior and inferior myocardial infarction showed that 39 (53.4%) and 51 (51%) smoked respectively. Conclusion: Smoking is a well-recognized strong modifiable risk factor and predictor of multivessel disease. Smoking cessation has been consistently associated with a mortality benefit in both stable coronary artery disease and post-acute coronary syndromes. Consequently, smoking cessation is one of the cornerstones of secondary prevention despite the improvement in the management of ACS with PCI and pharmacotherapy Keywords: Smoking, coronary vessels, territory and ST elevated myocardial infarction.

Malignant multi-vessel coronary vasospasm is a rare life threatening condition, presentation like myocardial infarction (MI), arrhythmias, and cardiogenic shock (CS). We report a case of IWMI complicated by CS, angiogram shows diffuse multi-vessel coronary artery spasm. Intracoronary nitroglycerine showing improving spasm in culprit vessel RCA and distal RCA stented with excellent result. This case of early diagnosis of coronary artery spasm to prevent the occurrence of MI, arrhythmias and sudden cardiac death as it is one the rare cause. It also highlighted the role of intracoronary nitroglycerine in relieving diffuse multi-vessel vasospasm in hemodynamically unstable patient.

Objectives: The main objective of the study was to evaluate the knowledge of patients for stents and post PCI pharmacotherapy. Methodology: A cross-sectional study was carried out on 102 consecutive selected patients with age ≥ 18 years who had undergone elective PCI. Various patient characteristics including demographics, previous history of cardiac problems, evaluation processes and overall knowledge were assessed using the survey questionnaire. With regards to evaluating levels of knowledge and awareness, the percentage for the number of correct answers about the dangers and advantages of elective PCI, clinical therapy for CAD, and bypass surgery was calculated. Results: A total of 102 patients were include, 78(76.5%) were male with mean age of study population was 53.93±11.0 years and majority 66(64.7%) were above 50 years of age. On analysis of demographics data it was observed that 74(72.5%) were educated. The results showed that adequate knowledge (≥70%) was observed only in 16.7% while there was not a single patient who answered all the questions in the correct fashion. Conclusion: Patients undergoing PCI had inadequate knowledge about the stents and post PCI pharmacotherapy.

Background The aim of this study was to determine the predictive value of the Global Registry of Acute Coronary Events (GRACE) score for predicting in-hospital and 6 months mortality after non-ST elevation acute coronary syndrome (NSTE-ACS). Results In this observational study, 300 patients with NSTE-ACS of age more than 30 years were included; 16 patients died during the hospital stay (5.3%). Of 284 patients at 6 months assessment, 10 patients died (3.5%), 240 survived (84.5%), and 34 were lost to follow-up (12%) respectively. In high risk category, 10.5% of the patients died within hospital stay and 11.8% died within 6 months (p = 0.001 and p = 0.013). In univariate analysis, gender, diabetes mellitus, family history, smoking, and GRACE score were significantly associated with in-hospital mortality whereas age, obesity, dyslipidemia, and GRACE were significantly associated with 6 months mortality. After adjustment, diabetes mellitus, family history, and GRACE score remained significantly associated with in-hospital mortality (p ≤ 0.05) and age remained significantly associated with 6 months mortality. Conclusion GRACE risk score has good predictive value for the prediction of in-hospital mortality and 6 months mortality among patients with NSTE-ACS.

Primary percutaneous coronary intervention (PCI) remains recommended reperfusion therapy for patients with acute ST-elevation myocardial infarction. This study aimed to evaluate the short-term major adverse cardiac events (MACE) and their determinants among patients who underwent primary PCI at a tertiary care cardiac center of Karachi, Pakistan.A cohort of patients who underwent primary PCI were followed for the MACE. Multivariable Cox-regression analysis was performed with backward conditional variable selection and hazard ratio (HR) along with 95% confidence interval (CI) were obtained.A total of 1150 patients were included, of which follow-up was successful in 95.8% (1102) and median follow-up duration was 6.1 [6.9-5.1] months. MACE were observed in 210 (19.1%) patients with 14.2% (157) all-cause mortality, 5.4% (60) cardiac mortality, 0.7% (8) stroke, 3.6% (40) re-hospitalization due to heart failure, and 6.1% (67) myocardial infarction requiring revascularization. Independent predictors of short-term MACE were found to be admission glucose ≥200 mg/dL (1.66 [1.25-2.21]), serum creatinine ≥1.5 mg/dL (1.52 [1.02-2.27]), intubation (2.81 [1.98-4.00]), history of PCI (2.06 [1.45-2.93]), history of cerebrovascular accident (2.64 [1.34-5.2]), left ventricular end-diastolic pressure ≥20 mmHg (1.81 [1.3-2.51]), triple vessel diseases (1.43 [1.08-1.9]), culprit left main or proximal left anterior descending artery (1.77 [1.32-2.35]), pre-ballooning (2.14 [1.2-3.82]), and thrombus grade ≥4 (2.21 [1.51-3.24]).A significant number of individuals undergone primary PCI are still vulnerable to subsequent short-term MACE, hence, systematic follow-up and early risk stratification should be considered as an integral part of STEMI management protocol specially for patients with high-risk features as highlighted herein.

Objectives: Prognostic importance of left ventricular end-diastolic pressure (LVEDP) is well established, hence, it is important to understand the factors associated with increased LVEDP for individualized risk stratification of ST-segment elevation myocardial infarction (STEMI) patients. There is dearth of data regarding clinical associates of elevated LVEDP, therefore, the purpose of current study was to evaluate the clinical indicators and phenotype of elevated LVEDP in STEMI patients undergoing primary percutaneous coronary intervention (PCI). Methodology: This descriptive observational study included patients diagnosed with STEMI and undergone primary PCI. LVEDP was measured using a fluid-filled pig-tail catheter before reperfusion but after angiography. Elevated LVEDP was taking as >25 mmHg. Results: A total of 498 patients were included, 23.7% (118) were female patients and mean age was 53.7 ± 11.7 years. Distribution of LVEDP was ≤15 mmHg in 48% (239), 15-25 mmHg in 42% (209), and >25 mmHg in remaining 10% (50) of the patients. Elevated LVEDP was found to be associated with increased heart rate (HR) with adjusted odds ratio of 1.05 [1.02-1.08], decreased systolic blood pressure (SBP) (0.95 [0.9-0.99]), Killip class II or high (9.36 [3.38-25.9]), and hypertension (4.63 [1.55-13.82]). Conclusion: Hemodynamic instability at presentation such as elevated HR, reduced SBP, higher Killip class and hypertension are the key indicators of elevated LVEDP.

Objectives The Zwolle risk score (ZRS) has been considered to be a useful tool for the systematic evaluation of patients for early discharge after primary percutaneous coronary intervention (PCI). Therefore, aim of this study was to evaluate the clinical utility of ZRS for the same-day discharge strategy after primary PCI at a tertiary care cardiac center of Karachi, Pakistan. Methods This study was conducted at a tertiary care cardiac center between August 2019 and July 2020. Patients discharged within 24 h (same-day) of the primary PCI procedure were included. Patients were stratified as high- and low-risk based on ZRS score; low-risk (≤3) and high-risk (≥4). All patients were followed during 30-days post-procedure period for major adverse cardiac events (MACE). Results Out of 487 patients, 83.2% (405) were male and mean age was 54.6 ± 10.87 years. Mean ZRS was 2.34 ± 1.64 with 16.0% (78) patients in high-risk (≥4) group. 30-days MACE rate was observed to be 5.3% (26) with significantly higher rate among high-risk patients as compared to low-risk patients 12.8% (10) vs. 3.9% (16); p = 0.004 respectively with OR of 3.61 [1.57–8.29]. The area under the curve (AUC) of ZRS for prediction of 30-day MACE was 0.67 [95% CI: 0.58–0.77], ZRS ≥4 had sensitivity of 38.5% and specificity of 85.2% with AUC of 0.62 [95% CI: 0.50–0.74] for prediction of 30-day MACE. Conclusion ZRS showed moderate discriminating potential in identifying patients with high-risk of MACE at 30-day after same-day discharge after primary PCI.

Multi-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.This 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..Comparing 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.Multi-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..