Pakistan Journal of Cardiovascular Intervention

Post–myocardial infarction ventricular septal rupture at a Pakistani tertiary cardiac center: documented short-term outcomes, management patterns, and unadjusted bivariable correlates in a retrospective observational cohort.

2026-02-07T04:52:37+00:00

Background: Post–myocardial infarction (MI) ventricular septal rupture (VSR) remains a devastating mechanical complication of acute MI, with persistently high mortality despite advances in reperfusion and structural cardiac intervention. In low- and middle-income settings, delayed presentation, referral barriers, and limited access to definitive repair may further affect outcomes. This study aimed to describe short-term outcomes, management patterns, and unadjusted bivariable correlates of confirmed outcome among patients with post-MI VSR at a tertiary cardiac center in Pakistan.

Methodology: This retrospective observational cohort study included consecutive patients with echocardiography-confirmed post-MI VSR presenting to the Peshawar Institute of Cardiology between January 1, 2023, and December 31, 2024. Data were abstracted from hospital records, discharge summaries, echocardiography reports, procedural documentation, and available follow-up records. Outcome status was classified as documented death, documented discharge/survival, or uncertain outcome.

Results: Among 51 patients, 20 (39.2%) had documented death, 15 (29.4%) had documented discharge alive or survival, and 16 (31.4%) had uncertain outcomes. Median age was 65.0 years [IQR, 59.5–71.0], and 22 (43.1%) were female. Hypertension, diabetes, and anterior MI were common. Most patients had no definitive repair documented (44/51, 86.3%). Among 35 patients with confirmed outcomes, no variable showed a statistically robust unadjusted association with short-term outcome.

Conclusion: Post-MI VSR was associated with substantial early mortality in this Pakistani cohort. However, incomplete follow-up and limited physiologic data restricted interpretation. Findings are exploratory and support the need for prospective multicenter studies with standardized follow-up.

Spectrum, Outcomes, and Safety of Catheter-Based Pediatric Cardiac Interventions: A One-Year Experience from a High-Volume Tertiary Care Center in Pakistan.

2026-02-07T04:34:29+00:00

Background: Congenital heart disease (CHD) is a major cause of childhood morbidity and mortality, particularly in low- and middle-income countries where access to specialized cardiac care is limited. In Pakistan, the annual burden of CHD is substantial. Catheter-based interventions provide minimally invasive alternatives to surgery for selected congenital cardiac lesions. This study aimed to describe the spectrum, outcomes, and safety of pediatric catheter-based cardiac interventions at a tertiary care center in Pakistan.

Methodology: This retrospective descriptive study was conducted at the Department of Pediatric Cardiology, Lady Reading Hospital-Medical Teaching Institution, Peshawar. Data were retrieved for all pediatric patients aged ≤18 years who underwent catheter-based cardiac procedures between January 1 and December 31, 2023. Demographic characteristics, procedural types, complications, procedure duration, and hospital stay were analyzed using descriptive statistics.

Results: A total of 603 catheter-based cardiac procedures were performed. Device closure procedures were the most common interventions, accounting for 447 cases (74.1%), including patent ductus arteriosus closure in 204 patients (33.8%), atrial septal defect closure in 160 (26.5%), and ventricular septal defect closure in 83 (13.8%). Balloon pulmonic and aortic valvuloplasty accounted for 10.4% and 3.0% of procedures, respectively, while diagnostic and therapeutic catheterizations comprised 12.4%. Males constituted 57.0% of patients. Major complications occurred in two patients (0.33%), both requiring device removal, while minor complications occurred in approximately 1.7%. Uncomplicated procedures required two to three days of hospital stay.

Conclusion: Pediatric catheter-based cardiac interventions were safe and effective, with low complication rates and favorable short-term outcomes in a resource-constrained setting.

Frequency and Determinants of ST-Segment Resolution Failure Following Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction.

2026-02-16T07:08:33+00:00

Background: This study aimed to determine the frequency of ST-segment resolution (STR) failure following primary percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI) and to evaluate its association with selected demographic and clinical characteristics.

Methodology: This prospective observational study was conducted in the Department of Cardiology, Hayatabad Medical Complex, Peshawar, Pakistan, from July 2025 to December 2025. A total of 103 patients aged 30–70 years diagnosed with STEMI and undergoing primary PCI were enrolled through consecutive sampling. ST-segment resolution was assessed using a standard 12-lead electrocardiogram within 30 minutes after PCI. STR failure was defined as a reduction of less than 30% in summed ST-segment elevation compared with baseline measurements. Demographic and clinical data were collected using a structured proforma. Statistical analysis was performed using SPSS version 25.

Results: Among the 103 enrolled patients, 55 (53.4%) experienced STR failure following primary PCI (95% CI: 43.5%–63.1%). The study population comprised 55 (53.4%) males and 48 (46.6%) females, with a mean age of 50.3 ± 11.4 years. No statistically significant associations were observed between STR failure and gender (p=0.693), smoking status (p=1.000), diabetes mellitus (p=0.555), hypertension (p=0.691), dyslipidaemia (p=0.425), or socioeconomic status (p=0.559). Rural residence demonstrated a borderline association with STR failure (p=0.074).

Conclusion: More than half of the STEMI patients in this cohort experienced ST-segment resolution failure despite undergoing primary PCI. Traditional cardiovascular risk factors were not significantly associated with STR failure, suggesting that procedural, angiographic, and microvascular determinants may play a more important role in post-PCI myocardial reperfusion. Larger multicenter studies incorporating comprehensive clinical and procedural variables are required to identify modifiable predictors and improve outcomes among STEMI patients.

Predictors of Side Branch Compromise After Provisional Stenting in Coronary Bifurcation PCI: Clinical and Angiographic Insights from a Tertiary Care Population.

2026-05-18T20:49:05+00:00

Background: Coronary bifurcation lesions account for 15–20% of percutaneous coronary interventions (PCI) and remain technically challenging. Provisional stenting is the recommended default strategy, yet side branch compromise (SBC) occurs frequently, potentially leading to periprocedural myocardial infarction (MI), impaired coronary perfusion, stent thrombosis, and adverse outcomes. Patients with diabetes, hypertension, or smoking-related vascular disease may be particularly susceptible. This study aimed to determine the frequency of SBC after provisional bifurcation PCI and identify clinical and angiographic predictors, focusing on diabetes, hypertension, and smoking.

Methodology: We conducted a retrospective observational study at the Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan, including consecutive patients undergoing provisional bifurcation PCI from January to June 2025. Clinical, procedural, and angiographic data were extracted from hospital records. SBC was defined as post-procedural TIMI flow <3 in the side branch.

Results: Among 400 patients (mean age 58 ± 10 years; 71.5% male), diabetes was present in 43.2%, hypertension in 59.8%, current smoking in 31.8%, and acute coronary syndrome in 29.2%. SBC occurred in 82 patients (20.5%, 95% CI 16.6–24.9%). Periprocedural MI was more frequent with SBC than without (22.0% vs. 4.4%, p<0.001). Independent predictors included moderate-to-severe calcification, smoking, diabetes, acute coronary syndrome, hypertension, pre-procedural TIMI 2 flow, side branch lesion length and ostial stenosis, and bifurcation angle. The predictive model demonstrated excellent discrimination (AUC = 0.999).

Conclusion: SBC affected one-fifth of patients undergoing provisional bifurcation PCI. Both clinical (smoking, diabetes, hypertension) and angiographic factors significantly predicted risk. Pre-procedural risk assessment integrating these factors may optimize procedural planning and improve outcomes.

Frequency and Predictors of Left Ventricular Thrombus in Patients with Acute Anterior Wall Myocardial Infarction: A Cross-Sectional Study from a Tertiary Care Cardiac Centre in Pakistan.

2025-09-08T08:38:52+00:00

Background: Left ventricular thrombus (LVT) is a significant complication of acute anterior wall myocardial infarction (AWMI), increasing the risk of systemic embolism, stroke, and adverse outcomes. This study aimed to determine the frequency of LVT and identify clinical predictors among patients with acute AWMI.

Methodology: An analytical cross-sectional study was conducted at the Department of Cardiology, Hayatabad Medical Complex, Peshawar, Pakistan, from July to December 2025. Ninety-one consecutive patients with acute AWMI were enrolled. Demographics, cardiovascular risk factors, ischemic time, and door-to-balloon time were recorded. Transthoracic echocardiography (TTE) was performed within 72 hours of admission to detect LVT. Associations between risk factors and LVT were analyzed using Chi-square tests, and independent predictors were identified via multivariable logistic regression. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported; p<0.05 was considered significant.

Results: LVT was detected in 20 patients (22%). On univariate analysis, hypertension (p=0.02) and diabetes mellitus (p=0.03) were significantly associated with LVT. After adjustment, diabetes mellitus (aOR=2.59, 95% CI: 1.37–4.88, p=0.003), smoking (aOR=3.07, 95% CI: 1.70–5.53, p=0.0002), and prolonged ischemic time (aOR=1.015 per minute, 95% CI: 1.005–1.025, p=0.0025) emerged as independent predictors. Door-to-balloon time was not significantly associated (p=0.11).

Conclusion: One in five patients with acute AWMI developed LVT. Diabetes, smoking, and delayed presentation independently predict thrombus formation. These findings highlight the need for timely reperfusion, reduction of pre-hospital delays, aggressive management of modifiable risk factors, and echocardiographic screening in high-risk patients. Larger multicenter studies using advanced imaging are warranted to validate these findings and improve risk stratification.

Transcatheter Device Closure of Congenital Ventricular Septal Defects: Procedural Outcomes and Short-Term Experience from a Tertiary Care Center in Pakistan.

2026-02-23T18:21:19+00:00

Background: Congenital ventricular septal defects (VSDs) are the most common congenital cardiac anomalies and may lead to left ventricular volume overload, pulmonary hypertension, arrhythmias, heart failure, or Eisenmenger syndrome if untreated. While surgery remains the conventional treatment, transcatheter device closure offers a minimally invasive alternative with shorter hospitalization and reduced morbidity.

Methodology: This retrospective observational study was conducted at Lady Reading Hospital-MTI, Peshawar, Pakistan, and included all patients who underwent attempted transcatheter closure of congenital VSDs from January 2023 to January 2026. Patients with hemodynamically significant left-to-right shunts and anatomically suitable defects on echocardiography were included. Clinical, echocardiographic, and catheterization records were reviewed to assess defect characteristics, device selection, procedural success, immediate outcomes, and complications.

Results: A total of 41 patients underwent attempted transcatheter VSD closure, with ages ranging from 12 months to 47 years. Perimembranous VSDs accounted for 70.7% of cases and muscular VSDs for 29.3%. Procedural success was achieved in 90.2% (37/41), with complete or trivial residual shunting on immediate imaging. Partial right coronary cusp prolapse was observed in 34.1% of patients, without progression to significant aortic regurgitation after device deployment. Major complications included device embolization in 4.8%, significant residual shunt in 2.4%, mild left ventricular outflow tract obstruction in 2.4%, and procedure-related mortality in 2.4%. No new significant aortic regurgitation or complete atrioventricular block was observed.

Conclusion: Transcatheter VSD closure showed high procedural success and favorable short-term outcomes, supporting its role as a safe, effective, valve-preserving alternative to surgery in selected patients, including in resource-limited settings.

The Coronary Artery Calcium Score Paradox: Evaluating the Discordance Between Coronary Artery Calcium Burden and Coronary Artery Disease Severity on Computed Tomography Angiography.

2026-03-06T17:16:51+00:00

Background: Coronary artery calcium (CAC) scoring is a non-invasive tool to estimate atherosclerotic burden and stratify cardiovascular risk. A CAC score of zero is traditionally considered indicative of low probability of obstructive coronary artery disease (CAD) and favorable prognosis. However, clinically significant non-calcified atherosclerosis may occur despite absent calcification, particularly among symptomatic individuals. This study aimed to investigate the relationship between CAC burden and CAD severity and evaluate the diagnostic performance of CAC scoring.

Methodology: In this retrospective observational study, 337 adults who underwent CAC scoring and coronary computed tomography angiography (CCTA) at Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan (2018–2023) were included. CAC was quantified using the Agatston method and categorized as CAC = 0 or CAC > 0. CAD severity on CCTA was classified as normal, non-obstructive (<50% stenosis), moderate obstructive (50–70%), or severe obstructive (>70%).

Results: The cohort comprised 245 males (72.7%) and 92 females (27.3%), mean age 50.3 ± 11.2 years. CAC = 0 was observed in 190 (56.4%) patients, among whom 61 (32.1%) had CAD, including 13 with obstructive CAD (p < 0.001). Obstructive CAD with zero CAC was more frequent in patients <45 years (25.0% vs 6.0% in older patients; p < 0.001). CAC discriminated plaque well (AUC 0.808, 95% CI 0.762–0.855; p < 0.001). CAC >0 showed 88.2% sensitivity, 78.0% specificity, 66.0% positive predictive value, and 93.2% negative predictive value for obstructive CAD.

Conclusion: CAC scoring demonstrates good diagnostic performance and high negative predictive value for obstructive CAD. Nonetheless, a notable proportion of symptomatic patients, especially younger individuals, had CAD despite zero CAC, emphasizing the need to combine CAC assessment with clinical evaluation and anatomical imaging for accurate risk stratification.

Association Between Liver Stiffness Severity and Atherosclerotic Cardiovascular Disease Risk Among Diabetic and Non-Diabetic Patients with Metabolic Dysfunction-Associated Fatty Liver Disease.

2026-03-17T05:51:34+00:00

Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) is closely linked to type 2 diabetes mellitus (T2DM) and heightened cardiovascular risk. Liver fibrosis, a marker of disease progression, has also been associated with adverse cardiovascular outcomes. This study compared liver stiffness, hepatic steatosis, and atherosclerotic cardiovascular disease (ASCVD) risk between diabetic and non-diabetic MAFLD patients and identified factors independently associated with elevated ASCVD risk.

Methodology: A hospital-based comparative cross-sectional study was conducted at Liaquat National Hospital, Karachi, Pakistan. A total of 240 adults with MAFLD confirmed by transient elastography (FibroScan®) were enrolled, including 120 diabetic and 120 non-diabetic participants. Hepatic steatosis was assessed using the controlled attenuation parameter (CAP), while liver fibrosis was measured by liver stiffness measurement (LSM). Demographic, anthropometric, biochemical, and cardiometabolic characteristics were compared. ASCVD risk was estimated using the PREVENT risk calculator.

Results: Diabetic participants were older and had higher HbA1c, ALT, total cholesterol, LDL/HDL ratio, serum creatinine, and ASCVD scores (all p<0.05). Advanced fibrosis was more frequent among diabetics (10.0% vs. 1.7%; p=0.015). Participants with high ASCVD risk exhibited higher total cholesterol, LDL/HDL ratio, CAP values, and fibrosis severity. Multivariable analysis identified age (OR=1.22; 95% CI: 1.13–1.32; p<0.001) and LDL/HDL ratio (OR=2.41; 95% CI: 1.47–3.97; p=0.001) as independent predictors. Diabetes, BMI, ALT, and LSM were not independently associated.

Conclusion: MAFLD patients with diabetes have worse metabolic profiles and greater fibrosis, but elevated ASCVD risk is primarily driven by age and atherogenic dyslipidemia rather than diabetes or liver stiffness, highlighting the need for comprehensive cardiometabolic risk assessment.

ORBITA-CTO: Liftoff for CTO PCI?

2026-01-22T07:17:04+00:00