Pakistan Journal of Cardiovascular Intervention

Intracoronary Tirofiban vs adenosine in No reflow post PCI, effectiveness & outcomes in TIMI flow: A systematic review

2023-12-19T16:50:20+00:00

Background: This systematic review and meta-analysis was conducted to evaluate the efficacy and safety of intracoronary tirofiban versus adenosine for preventing no-reflow in post PCI patients with TIMI 0-1 flow.

Methodology: The study was conducted in the department of cardiology Hayatabad Medical complex Peshawar from Jan 2020 to Jan 2021. The systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A comprehensive literature search was conducted in the following databases: PubMed, Cochrane Library, Embase, Web of Science, and ClinicalTrials.gov. The search was conducted without any language restriction. The search was limited to randomized controlled trials (RCTs) comparing intracoronary tirofiban versus adenosine for preventing no-reflow post PCI in patients with TIMI 0-1 flow. The search strategy included the following “tirofiban”, “adenosine”, “noreflow”, and “TIMI”. The reference lists of included studies were searched for additional relevant studies.

Results: A total of 7 studies (n = 1,719) were included in the meta-analysis. Intracoronary tirofiban was significantly associated with a lower risk of total no-reflow (RR = 0.59, 95% CI 0.37–0.94, P = 0.02) as well as MBG 0-2 (RR = 0.39, 95% CI 0.22– 0.69, P = 0.001). There was no significant difference in MACCE between the 2 groups (RR = 0.73, 95% CI 0.43–1.21, P = 0.22).

Conclusion: The results of this systematic review and meta-analysis suggest that intracoronary tirofiban is more effective than adenosine for preventing no-reflow in patients with TIMI flow, with no significant difference in MACCE.

Two Cases of Acute Compartment Syndrome as Complication of Transradial Approach in STEMI: What Can Go Wrong and Lesson Learnt

2023-07-10T04:50:14+00:00

Background: Some studies showed the transradial approach (TRA) to be superior in terms of reducing bleeding complications and is related with lower 30-day mortality in patients with ST-elevation myocardial infarction (STEMI), while maintaining equal rates of TIMI 3 flow and procedural success. Nevertheless, TRA still present with a variety of complication, such as forearm hematoma and acute compartment syndrome, requiring a prompt surgical approach. Here, we present 2 cases of successfully managed acute compartment syndrome following primary Percutaneous Coronary Intervention (PCI) after STEMI.

Case Presentation: First patient, male, 42-year-old, transported to Siloam Diagram Heart Hospital with anterior STEMI with an onset of 6 hours. He has a history of hypertension and is an ex-smoker. Electrocardiography (ECG) shows elevation in ST segment leads V1-V4. The second patient, male, 62-year-old, came with an extensive STEMI with an onset of 13 hours. He is an active smoker with no history of chronic diseases. ECG shows RBBB and ST elevation in lead V2-V6, I, and aVL. Both underwent primary PCI procedures and developed forearm hematoma with compartment syndrome.

Management and Results: The first case was related to a laceration of the radial artery, and the second case was related to the compression band being positioned incorrectly in relation to the actual arteriotomy location. Both are successfully managed with a surgical approach with no neuromusculovascular sequelae.

Conclusion: CS might occur as a complication after the procedure caused by many conditions. Early recognition is essential to prevent neuromusculovascular complications.

Outcomes of drug (paclitaxel) coated balloons in various coronary lesion subsets; A two-year follow-up study.

2023-09-13T08:03:27+00:00

Background: Drug-coated balloons (DCB) are a promising treatment for coronary artery disease (CAD), but their long-term efficacy in different lesion subsets is unknown. This study assessed the clinical outcomes of paclitaxel-coated balloons over two years, examining various lesion types and patient characteristics.

Methodology: This retrospective cohort study analyzed 102 patients who underwent drug-coated balloon (DCB) treatment for denovo or restenotic lesions. Paclitaxel-eluting balloons were utilized, and the primary objective was to assess the occurrence of major adverse cardiovascular events (MACE), defined as death, myocardial infarction, target lesion revasculariazation, and target vessel revascularization at different time intervals. Secondary outcomes, including target lesion failure (TLF), target lesion revascularization (TLR), target vessel revascularization (TVR), and target vessel myocardial infarction (TVMI), were also evaluated. Statistical analysis was conducted using SPSS version 22.0.

Results: In this study, the mean age of the participants was 58.49 years, with the majority being male (81.4%). Lesion types included both de novo (49.0%) and in-stent restenosis (ISR) (51.0%). Bifurcation lesions were present in 29.4% of cases, and ostial lesions were observed in 40% of cases. Thrombus was found in 4.9% of cases. The occurrence of MACE was low, with one patient experiencing MACE at 30 days, nine patients between 30 days and 1 year, and six patients between 1 and 2 years. The overall rates of TLF, TLR, TVR, and TVMI were also low. Some patient characteristics, such as diabetes, dyslipidemia, chronic kidney disease (CKD), and dialysis, were associated with a higher risk of MACE. Importantly, no significant differences in outcomes were observed between various lesion subsets and presentations.

Conclusion: DCB proves to be a viable and efficient treatment option for different types of coronary lesions. The occurrence rates of MACE, TLR, TLF, TVR, and cardiac death following the use of DCB are low.

Virtual histology of coronary arteries using intravascular ultrasound (IVUS) - local experience.

2023-09-13T08:10:02+00:00

Background: In the occurrence of coronary events, atherosclerotic plaque characteristics have been demonstrated to play a pivotal role. Based on histological studies of victims of sudden cardiac death, lesions containing a large amount of necrotic core with an overlying thin fibrous cap (referred to as thin cap fibroatheroma TCFA) have been linked to plaque rupture. In vivo detection of potentially vulnerable plaques may improve the prevention of cardiovascular events.

The aim of the study was to find out the pattern of plaque morphology using VH-IVUs in our population.

Methodology: This descriptive study was conducted in Lady Reading Hospital, Peshawar. We enrolled patients with a history of coronary artery disease admitted for coronary angiography from 2007 to 2011. Virtual histology was obtained for the fibrofatty, fibrous, calcified, and necrotic plaques. The sizes of the vessels and lumen were measured. The results of the study were mentioned in mean, standard deviation, and percentage of different variables.

Results: A total of 41 patients were studied. The mean age was 56.3 years (+ 9.9 SD). Males were 29 (70.7%). Chest pain was almost reported by all patients (100%). Acute coronary syndrome (ACS) diagnosis was present in 23 patients (56.1%), while patients with chronic coronary syndrome (CCS) were 18 (43.9%). The Minimum plaque burden was 58.5%, while the maximum was 89.6%, with a mean value of 73.1%. The most common plaque type was fibrous (77.3% SD +6.4), followed by fibro¬fatty plaque (13.02% SD +3.5). The necrotic type was 7.09 % SD +6.2, while calcified plaque was 2.2% SD + 1.4.

Conclusion: Fibrous type plaque was the most common type of VH IVUS in both CCS patients and the ACS group; However, necrotic core was comparatively more in the ACS group.

Effect of Intracoronary Vs. Intravenous Tirofiban Bolus on Myocardial Flow Grades in Acute STEMI

2023-07-07T06:15:10+00:00

Background: There are a few studies about the advantages and risks of using tirofiban via the intracoronary vs intravenous route in patients with ST-segment elevation myocardial infarction. In this study, the comparison of the efficacy of intracoronary vs intravenous tirofiban is assessed.

Methodology: This comparative study was conducted at the Punjab Institute of Cardiology, Lahore, from March 2019 to March 2020. A total of 250 patients of both genders, aged between 20 to 65 years, were enrolled in this study (March 2019 to March 2020) who had STEMI and had high thrombus burden or TIMI flow grade <3 During Primary PCI. The patients were divided into two groups, namely the intracoronary tirofiban group and the intravenous tirofiban group. Both groups were compared for final TIMI flow and Myocardial blush grade. Moreover, major and minor bleeding, hematoma and mortality was compare among both groups. The data was analyzed using SPSS v23.0. The chi-square test was applied to obtain the comparative analysis. A p-value ≤0.05 was considered statistically significant.

Results: TIMI flow grades in both groups were not similar and showed significant differences, which indicated that both groups were independent as p-value <0.05. TIMI flow grade III was achieved in 83.2% in group A, whereas in group B, it was only 28.8%. The myocardial blush grade was compared in both groups, and the result showed that scores in both the groups were not similar, having significant differences as the p-value was 0.00 (84.8% vs. 46.4%), major and minor bleeding results were compared among both groups and showed statistical insignificance results as p-value = 0.625 (6.4% vs. 8.0%) and 0.705 (12% vs. 13.6%) respectively. The Chi-square results regarding hematoma, Major Adverse Cardiovascular Events (MACE), and mortality in intracoronary and intravenous tirofiban groups were not statistically significant as the p-values were 0.338 (30.4% vs. 27.2%), 0.447 (34.4% vs. 32.8%) and 0.591(2.4% vs. 3.2%) respectively.

Conclusion: In contrast to intravenous administration, the intracoronary administration of tirofiban has shown a superior improvement in myocardial flow grades, including TIMI-flow grade and Myocardial blush grade

Mortality Pattern in STEMI patients treated with Primary PCI during COVID-19 era at Manchester Heart Centre

2023-10-28T15:38:12+00:00

Background: The COVID-19 pandemic dramatically transformed the healthcare provision in the United Kingdom as the National Health Service (NHS) adopted to deal with the unexpected health emergency. Many well-established systems to deal with known acute conditions had to be adopted so that available resources can be utilized in the best possible efficient way. As with all regions with the UK, the greater Manchester cardiac services dealing with acute STEMI and providing primary PCI were reorganized with specific guidelines and clear pathways put in place, this led to significant change in the long-standing clinical practice for the acute management of PPCI.

Methodology: The effects of these changes were assessed by observing the overall mortality during the 3 months of strict lockdown introduced in the UK to contain the spread of COVID-19 and then comparing this with the corresponding 3 months in the preceding year.

Results: In this study we have highlighted the impact of COVID-19 pandemic on STEMI patients who underwent PPCIs. In this study, a total of 262 patients in both periods (March-June 2019) and (March-June 2020) were treated for PPCI. There were 15 mortalities in both periods. Among them majority were males (86.7%) while (13.3%) were females.

Conclusion: Although the mortality was high (53.3%) during the COVID-19 period as compared to 2019 (47.7%), there does not appear to be any causative/confounding relationship with the COVID-19 pandemic itself.