Medicine and Health Sciences Commons^™

Predictors Of Coronary Artery Disease In Heart Failure With Reduced Ejection Fraction At The Aga Khan University Hospital In Nairobi, Redemptar Kimeu, Jeilan Mohamed, Mzee Ngunga

Internal Medicine, East Africa

There appears to be an epidemiological transition in the etiology of heart failure in sub-Saharan Africa (SSA) in parallel with a steady increase in risk factors for coronary artery disease (CAD). SSA has limited access to heart failure and CAD diagnostics, limiting the number of patients who receive optimal care. Our objectives were to study the predictors of coronary artery disease among patients with heart failure with reduced ejection fraction (HFrEF) and develop a model to assist clinicians in determining the likelihood of CAD before cardiac catheterization.

Methodology: This was a retrospective study at the Aga Khan University Hospital, …

Determinant Of Repeat Revascularization Within 5 Years Of Percutaneous Coronary Lntervention At A Tertiary Care Hospital, Karachi: A Matched Case-Control Study, Komal Valliani, Azmina Artani, Iqbal Azam, Javed Tai, M. Masood Kadir

Community Health Sciences

Objective: To determine factors associated with repeat revascularization among adults aged 25 years and above within 5 years of first Percutaneous Coronary Intervention (PCI) at a tertiary care hospital.
Methods: A matched case-control study was conducted through a hospital records review. A total of 90 cases with repeat revascularization and 180 controls without repeat revascularization were included. Data was analyzed using Multiple Conditional Logistic Regression.
Results: The mean age was similar in cases and controls (60.05 ± 10.01 vs 62.20 ± 10.43 years) and sex (male: 77.8% vs. 76.1%). History of being an ever-smoker (40% vs. 25%), overweight (36.3% vs. …

Trend, Predictors, And Outcomes Of Combined Mitral Valve Replacement And Coronary Artery Bypass Graft In Patients With Concomitant Mitral Valve And Coronary Artery Disease: A National Inpatient Sample Database Analysis, Waqas Ullah, Sajjad Gul, Sameer Saleem, Mubbasher Ameer Syed, Muhammad Zia Khan, Salman Zahid, Abdul Mannan Khan Minhas, Salim S. Virani, Mamas A. Mamas, David L. Fischman

Office of the Provost

Aims: Combined mitral valve replacement (MVR) and coronary artery bypass graft (CABG) procedures have been the norm for patients with concomitant mitral valve disease (MVD) and coronary artery disease (CAD) with no large-scale data on their safety and efficacy.
Methods and results: The National Inpatient Sample database (2002-18) was queried to identify patients undergoing MVR and CABG. The major adverse cardiovascular events (MACE) and its components were compared using a propensity score-matched (PSM) analysis to calculate adjusted odds ratios (OR). A total of 6 145 694 patients (CABG only 3 971 045, MVR only 1 933 459, MVR + CABG …

Comparative Trends In Ischemic Heart Disease Admissions, Presentation And Outcomes Due To The Covid-19 Pandemic: First Insights From A Tertiary Medical Center In Pakistan, Ali Aahil Noorali, Humza Thobani, Shiraz Hashmi, Sara Iqbal, Asma A H. Merchant, Mian Arsam Haroon, Sardar Shahmir Babar Chauhan, Saad Mallick, Nida Zahid, Yasir Khan, Osman Faheem, Saulat Fatimi

Department of Medicine

Introduction: COVID-19 has manifested a striking disarray in healthcare access and provision, particularly amongst patients presenting with life-threatening ischemic heart disease (IHD). The paucity of data from low-middle income countries has limited our understanding of the consequential burden in the developing world. We aim to compare volumes, presentations, management strategies, and outcomes of IHD amongst patients presenting in the same calendar months before and during the COVID-19 pandemic.
Methods: We conducted a retrospective cross-sectional analysis at the Aga Khan University Hospital, one of the premier tertiary care centres in Pakistan. Data were collected on all adult patients (>18 years) …

Outcomes Of Left Main Percutaneous Coronary Intervention, Nasir Rahman, Bilal Hussain, Azmina Artani

Section of Cardiology

Objective: To study the outcomes of left main percutaneous coronary artery (LMCA) revascularisation.

Study Design: A descriptive study.

Place and Duration of Study: The Aga Khan University Hospital (AKUH), Karachi, from February till July 2016.

Methodology: The study included all adult patients aged 18 years or more, who underwent percutaneous LMCA revascularisation at study centre from April 2006 till April 2015. In-hospital outcomes were ascertained of patients via charts along with telephonic follow-up for outcome ascertainment at 1-year and 5-year. Results were expressed in terms of means and standard deviation for quantitative variables and percentages for qualitative variables.

Results: Of …

Subsequent Event Risk In Individuals With Established Coronary Heart Disease, Riyaz S. Patel, Vinicius Tragante, Amand F. Schmidt, Raymond O. Mccubrey, Michael V. Holmes, Laurence J. Howe, Kenan Direk, Axel Åkerblom, Karin Leander, Salim S. Virani

Office of the Provost

Background: The Genetics of Subsequent Coronary Heart Disease (GENIUS-CHD) consortium was established to facilitate discovery and validation of genetic variants and biomarkers for risk of subsequent CHD events, in individuals with established CHD.
Methods: The consortium currently includes 57 studies from 18 countries, recruiting 185 614 participants with either acute coronary syndrome, stable CHD, or a mixture of both at baseline. All studies collected biological samples and followed-up study participants prospectively for subsequent events.
Results: Enrollment into the individual studies took place between 1985 to present day with a duration of follow-up ranging from 9 months to 15 years. Within …

Diastolic Dysfunction In Coronary Artery Disease, Sarwat Hashmi, H R. Ahmad, Hasanat Sharif, Syedah Saira Bokhari

Department of Biological & Biomedical Sciences

No abstract provided.

Almond Supplementation Reduces Serum Uric Acid In Coronary Artery Disease Patients: A Randomized Controlled Trial., Humaira Jamshed, Anwar Gilani, Fateh Ali Tipoo Sultan, Faridah Amin, Jamshed Arslan Arslan, Sumaira Ghani, Madiha Masroor

Department of Biological & Biomedical Sciences

Objective

Elevated serum uric acid (UA), a biomarker of renal insufficiency, is also an independent prognostic marker for morbidity in coronary artery disease (CAD) and poses serious health risks. This study reports the effect of almond consumption on UA in CAD patients.

Study design

A randomized controlled clinical trial was conducted with three groups: no-intervention (NI), Pakistani almonds (PA) or American almonds (AA). Patients were recruited from the Cardiology Clinics, Aga Khan University Hospital. Two follow-ups were scheduled at week-6 and week-12. 150 patients were randomly divided in three groups (50 per group). NI was not given almonds, whereas the …

Galectin-1 In Early Acute Myocardial Infarction, Suhail Al-Salam, Satwat Hashmi

Department of Biological & Biomedical Sciences

Myocardial infarction (MI) is the most serious manifestation of coronary artery disease and the cause of significant mortality and morbidity worldwide. Galectin-1(GAL-1), a divalent 14.5-kDa protein, is present both inside and outside cells, and has both intracellular and extracellular functions. Hypoxia inducible factor-1 alpha (HIF-1α) is a transcription factor mediating early and late responses to myocardial ischemia. Identification of the pattern of expression of GAL-1 and HIF-1α in the heart during the first 24 hours following acute MI will help in understanding early molecular changes in this event and may provide methods to overcome serious complications. Mouse model of MI …

Imaging And Intervention For Coronary Artery Disease Following Irradiation Of Malignant Thymoma, Saulat H. Fatimi, Salima Ahmed Bhimani, Ranish Deedar-Ali- Khawaja, Ali Khawaja

Section of Cardiothoracic Surgery

Thymomas are rare malignant epithelial growths, constituting 20% of mediastinal tumours. Resection followed by irradiation may be employed in all thymomas except for stage 1 thymomas. Mediastinal irradiation is associated with coronary artery disease. The mean duration of presentation of post-irradiation coronary artery disease is 16 years (range 3-29 years). In our patient coronary artery disease was found only a year post irradiation. A 55 year old male who presented with complaints of dyspnoea, retrosternal chest pain and heaviness since one year underwent resection for malignant thymoma followed by radiotherapy. He presented with coronary artery disease a year after undergoing …

Carotid Cavernous Fistula In A Patient With Coronary Artery Disease, Omer Ashraf, Syed Shahabuddin, Muhammad Ehsan Bari, Hasanat Sharif

Section of Cardiology

Carotid cavernous fistulas are abnormal communications between the carotid and cavernous vasculature, with potential for serious neurological and ocular sequelae. There is considerable literature on the neuro-radiological management of carotico-cavernous fistula depending upon their flow status. The coronary artery bypass grafting (CABG) for coronary artery disease (CAD) is a well established method of revascularization. However, the association of carotid cavernous fistula in presence of CAD is an infrequent occurrence. We present a case of coronary artery disease scheduled for bypass surgery, developed spontaneous bilateral carotid cavernous fistulas, highlighting a unique aspect of association between coronary and carotid disease.

Percutaneous Coronary Intervention In Unprotected Left Main Coronary Artery Disease, Hafeez Ahmed, Javed Majid Tai, Sajid H. Dhakam

Section of Cardiology

Percutaneous coronary intervention for unprotected left main coronary artery disease is potentially an important intervention in surgically unstable patients. A detailed review of medical record and visual analysis of coronary angiography and PCI procedure was undertaken. The study was conducted at the Aga Khan University Hospital, from January 2003 to December 2007. Patients included in the study had unprotected > 70% left main stenosis with ongoing ischemia, considered unsuitable for surgical revascularization. A total of 9 patients were included with a mean age of 70.1 years. Six patients had cardiogenic shock. Eight patients had bifurcation lesion. Simultaneous kissing stenting technique was …

Knowledge Of Coronary Artery Disease (Cad) Risk Factors And Coronary Intervention Among University Students, Aysha Almas, Aamir Hameed, Fateh Ali Tipoo Sultan

Section of Cardiology

OBJECTIVE: To elucidate knowledge of coronary artery disease (CAD) risks factors and coronary intervention in adult students of Karachi East. To calculate the mean knowledge score about CAD risk factors among them.

METHODS: A multi center crossectional study was conducted in Universities and colleges of Karachi East from April-September 2005. Questionnaires were distributed to 200 adult students of different non-medical universities and colleges. The questionnaire contained assessment of knowledge of risk factors on CAD and awareness about coronary angiography. Those belonging to medical colleges and universities were excluded from the study. Knowledge was assessed as a continuous variable. Risk factors …

Clinical Outcomes Of Sirolimus With Eluting Stent Implantation In Coronary Artery Disease, Munsif Ali, Syed Mumtaz Ali Shah, Zaman Shah, Islam Hussain, Khezar Shahzada Syed, Hadi Mohammad Khan

Section of Cardiology

OBJECTIVE: To evaluate the immediate post procedure, thirty-days, and six-months clinical outcomes of sirolimus-eluting stents (SES) implantation in patients with single and multivessel coronary artery disease (CAD).

METHODS: A case series of all consecutive patients undergoing percutaneous coronary interventions (PCI) with SES implantation at Shifa International Hospital, Islamabad, were evaluated at early post-procedure, 30-days and six-months clinical follow-up for the incidence of major adverse cardiac event (MACE). This included death, nonfatal myocardial infarction (MI) and repeat revascularization.

RESULTS: Out of 206 consecutive patients, 324 had SES implanted. Cumulative MACE rate was 2.93% and 6% at 30-days and six-months follow-ups respectively. …

Risk Factors And Behaviours For Coronary Artery Disease (Cad) Among Ambulatory Pakistanis, S P. Iqbal, S Dodani, Riaz Qureshi

Department of Family Medicine

Objective: To determine the frequency and distribution of various risk factors and behaviours for coronary artery disease (CAD) among ambulatory Pakistanis.
Methods: It is a cross-sectional descriptive study carried out at the Aga Khan University Hospital, a teaching hospital in Karachi. All the subjects were adults (18-60 years) presenting at the general checkup clinic with no history or evidence of CAD by convenient sampling method. Demographic variables included risk factors and behaviors including diabetes, hypertension, dyslipidemia, family history of heart disease, obesity, smoking and sedentary lifestyle.
Results: Among 370 ambulatory Pakistanis, the proportions of major risk factors for CAD were: …