https://pjcvi.com/index.php/ojs <p><strong>Pakistan Journal of Cardiovascular Intervention (PJCVI)</strong> is biannual, open access, peer-reviewed journal of the Pakistan Society of interventional cardiology. The journal publishes original research, reviews, short communication, case studies, commentaries and editorials focusing on interventional procedures and techniques. PJCVI provides a platform for determined cardiologists to stay relevant in diagnosing and analyzing, researching, and managing patients with cardiovascular disease and its allied complications.</p> <p><br />The field of interventional cardiology is briskly evolving with innovation and technological progress. The profile of interventional cardiology has risen to the extent that it is now one of the most dynamic subspecialties in mainstream medical practice with the help of experts in molecular biology, biomedical engineering, biophysics and imaging technology. The journal will provide a platform for annotation, discussion and new findings.</p> Pakistan society of interventional cardiology en-US Pakistan Journal of Cardiovascular Intervention 2790-4415 https://pjcvi.com/index.php/ojs/article/view/95 <p><strong>Background:</strong> Right coronary artery (RCA) ST-elevation myocardial infarction (STEMI) is a critical cardiovascular condition that can lead to significant morbidity and mortality if not treated promptly. Primary percutaneous coronary intervention (PCI) is the gold standard for managing STEMI patients. The objective of this study is to evaluate clinical characteristics and outcome of proximal versus non-proximal, in dominant “right coronary artery (RCA) ST-elevation myocardial infarction (STEMI)” patients undergoing primary PCI at NICVD, Karachi.</p> <p><strong>Methodology:</strong> This retrospective comparative cross-sectional study included equal number of consecutive patients diagnosed with dominant “RCA STEMI” with culprit proximal and non-proximal lesions undergoing primary PCI. In-hospital clinical outcomes including mortality, heart failure, cardiogenic shock, ventricular arrhythmias, myocardial infarction, stent thrombosis, AV block, TPM placement, IABP placement, and other procedure-related complications were compared between the two groups.</p> <p><strong>Results:</strong> Total 355 patients each with proximal lesions and non-proximal lesions were included. Age was similar between the two groups, with no significant difference observed (56.9 ± 10.8 years vs. 56 ± 10.4 years; p = 0.367). Pre-procedure TIMI flow was significantly worse in the proximal lesion group compared to the non-proximal lesion group (TIMI 0: 70.1% vs. 66.8%; p = 0.015). Delay in PCI was noted for 107 (30.2%) vs. 68 (19.2%); p=0.001in proximal compared to the non-proximal group, respectively.</p> <p><strong>Conclusion:</strong> Proximal lesions appear to be associated with poorer initial coronary blood flow and a higher likelihood of in-hospital mortality. Further, a significant delay in intervention was observed for proximal group. Hence, these findings revealed the importance of timely intervention and tailored management strategies based on lesion location in optimizing outcomes for STEMI patients.</p> Fayaz Ali Nimra Ashraf Qamar Zamaan Qaimkhani Gohar Riaz Wajid Ali Khalid Iqbal Bhatti Jehangir Ali Shah Muhammad Naeem Mengal Jawaid Akbar Sial Abdul Hakeem Tahir Saghir Copyright (c) 2024 The Author https://creativecommons.org/licenses/by/4.0/ 2024-10-29 2024-10-29 1 7 https://pjcvi.com/index.php/ojs/article/view/96 <p><strong>Background: </strong>ECG remains the mainstay of diagnosis of STEMI in clinical practice and proper interpretation helps to identify the culprit artery. We present a rare case in which ST elevation in ECG proved to be quite misleading.</p> <p><strong>Case Presentation: </strong>We present the case of an elderly male patient who presented to emergency department with acute onset of severe chest pain. Ecg done in emergency department which showed inferior wall myocardial infarction (MI) complicated by complete heart block. He underwent angioplasty of right coronary artery. Patient in CCU developed ST elevation in anterior chest leads which was attributed to RV branch occlusion.</p> <p><strong>Management and Results: </strong>Patient was managed medically as he was pain free and hemodynamically stable. Serial ECG’s done. He was strictly monitored in CCU for any hemodynamic or electrical instability. Patient remained pain free throughout his stay in CCU. After 6 to 8 hours ST segment elevation completely settled down with no Q wave formation.</p> <p><strong>Conclusion:</strong> ST segment elevation in anterior leads is hallmark of anterior wall MI. Interestingly, isolated right ventricle MI can also produce similar changes in ECG. Very few case reports found on management of isolated RV branch occlusion and patient can present with a wide spectrum of clinical presentation from being completely asymptomatic to suffering from cardiac arrest. Management of isolated RV branch occlusion is another dilemma and it can vary from case to case.</p> Maryum Masoud Copyright (c) 2024 The Author https://creativecommons.org/licenses/by/4.0/ 2024-10-29 2024-10-29 8 12