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Article
Admission plasma glucose level among non-diabetic patients sustaining acute coronary syndrome

Author: Hussein S. Sakhi
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2011 Volume: 10 Issue: 1 Pages: 1-7
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Background Stress hyperglycemia occurs in 5−30% of patients with apoplexy, myocardial infarction, sepsis, trauma and other critical illnesses, and it correlates with poor outcome. Aims: assessment of the prevalence of admission hyperglycemia among acute coronary syndrome patients and its impact on the outcome. Patients and methods Observational case control study had recruited 80 non-diabetic adults’ patients (43 males, 37 females) who were randomly selected after admission to the CCU/department of medicine/ Al-Yarmouk Teaching Hospital in the period from March to October 2009 because of acute coronary syndrome. Detailed history and physical examination were done, body mass index, waist-hip-ratio were recorded, venous blood sample were taken from patients to measure plasma glucose level and HbA1c; ECG and echocardiogram were done to all patients included in the study. Results 80 patients (43 males, 37 females) completed the study, their age groups ranging from 37-76 years, 3 patients were excluded from the study (2 male, 1 female) when they found to have high HbA1c ( ≥6.5%). 16 patients (20.6% of total no.) (7 male, 9 female) with a mean age of (62.19±7.17) were found to have casual admission (stress) hyperglycemic, a p value <0.05. Hyperglycemia is more likely associated with a female gender, advancing age, higher BMI, android pattern of body fat distribution, and higher killip classes (III, IV). Conclusions Casual admission (stress) hyperglycemia is not uncommon among non- diabetic adults admitted for acute coronary syndrome. Poorer outcome in patients with ACS is more likely among those with higher glycemic level, especially with advancing age, female gender and increased total body fat.


Article
SERUM LEVELS OF INTERLEUKIN-1 ALPHA AND INTERLEUKIN-6 IN ACUTE CORONARY SYNDROME PATIENTS

Authors: Kismat M Turki قسمة محمد تركي --- Mohammed O Hamzah محمد عمران حمزة
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2011 Volume: 9 Issue: 3 Pages: 281-284
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

BackgroundCytokines are responsible for the modulation of immunological and inflammatory processes and play a significant role in the pathogenesis of acute coronary syndrome patients (ACS).ObjectiveThis study aims to investigate the serum levels of IL-1α and IL-6 in ACS patients.MethodsThe study covered 140 subjects. It comprised a total of 101 patients with ACS patients [62 with acute myocardial infarction (AMI) and 39 with unstable angina (UA)], compared with 39 healthy individuals with no history of cardiac disease. Serum IL-1α and IL-6 analysis was performed by ELISA.ResultsThe present results revealed that there were significant elevation in mean serum levels of IL-1α and IL-6 in patients with ACS ( AMI and UA) as compared to healthy control (P<0.001). Moreover, the levels of these cytokines were significantly higher in AMI patients when compared to UA patients (P<0.001).ConclusionThese finding suggest that IL-1α and IL-6 play an important role in pathogenesis of ACS.KeywordsAcute coronary syndrome, IL-1α and IL-6.


Article
The Value of Admission Glucose and Glycosylated Hemoglobin in Patients with acute Coronary Syndrome

Authors: Manal Khudhur Abdul Razzaq --- Jawad Ibrahim Rasheed --- Haider Shaheed Mohmmad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 1 Pages: 75-84
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: In nondiabetic patients, elevated admission glucose level is a strong predictor of short-term adverse outcome in patients with acute coronary syndrome. Admission glucose may be affected by meals, the circadian cycle, and also the stress response. Glycated hemoglobin A1c is a convenient marker of long-term glucose regulation. However, the prognostic value of diabetic control assessed by HbA1c level in patients with acute coronary syndrome (ACS) is still undefined.OBJECTIVE: To determine the association between (admission glucose and HbA1c) and short term outcome in patients not known to be diabetics presented with ACS.PATIENTS AND METHODS: This observational study included 50 consecutive patients without known diabetes mellitus admitted to the coronary care unit with ACS. Patients were sub-divided into three groups: patients with unstable angina (UA, n = 10), those with ST segment elevation myocardial Infarction (STEMI, n = 18) and those with non ST segment elevation myocardial infarction (NSTEMI, n = 22). Patients were stratified according to their HbA1c into three groups: Group 1: <6.5 (12, 24%), group 2: 6.5- 8.5 (22, 44%) and group 3: > 8.5 (16, 32%). Both glucose and HbA1c were measured on admission. The diagnosis of ‘‘undiagnosed DM’’ was made if patients presented with fasting glucose >7.0 mmol/L or random glucose >11.1 mmol/L together with an admission HbA1c >6.5% according to the latest ADA recommendations. Main outcome measure was left ventricular (LV) systolic function which was assessed by ejection fraction (EF); and the set point was 50%. Data were analyzed separately using multiple regression analysis.RESULTS: The mean age of patients was 60.6 ± 6.33 years and 74% were males. Of total, 42% were smokers, 68% were hypertensive, 48% had hyperlipidemia and BMI ≥ 30 in 22%. Eighteen percent of patients were diagnosed as new cases of DM. Mean admission glucose was higher in patients with EF< 50% compared to those with EF> 50% with statistically significant difference (P< 0.05). There was a linear correlation between EF% and HbA1c in all types of presentation. 95.5% of patients in group 2 and 100% of patients in group 3 showed EF<50% with statistically significant difference (P< 0.05). CONCLUSION: HbA1c on admission is a powerful predictor of LV systolic dysfunction as a major adverse event of acute coronary syndrome in patients not known to be diabetics. Measurement of HbA1c levels may improve risk assessment in those patients when presenting with ACS


Article
Troponin Positive Acute Coronary Syndrome with and without Significant Stenosis on Coronary Angiography

Authors: Mohammed Hilal AL-Ali --- Hassan A. Farhan
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 2 Pages: 237-243
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Occasionally, coronary arteries without significant stenosis are observed during invasive treatment of acute coronary syndrome (ACS). OBJECTIVE: The aim was to study the frequency and to determine the most predictive factors of Troponin positive ACS without significant Stenosis on angiography.METHODS:The study involved one hundred twenty four patients admitted with Troponin positive ACS who underwent cardiac catheterization during hospitalization. The primary end-point was the estimation of coronary arteries without significant stenosis, and the secondary end-point was analysis of the most predisposing factors. In evaluating the primary end-point, the patients were divided into two groups according to the presence of ST elevation myocardial infarction (STEMI) or not. Also the patient who has no significant coronary artery Stenosis (< 50%) was subdivided to two groups:a- Myocardial Infarction with No critical lesion in Coronary angiogram (MINC)b-Normal coronary angiogramRESULTS: Overall, 20 patients (16%) had coronary arteries without significant lesions, from which 8 patients (6.4%) had MINC and 12 patients (9.6%) had normal coronary angiogram. The predictors were: female sex (P=0.008), age <45 years (P=0.001), and the absence of: diabetes (P=<0.001), hypertension (P=0.005) and absence of ST-segment elevation (P=0.001). Furthermore absence of regional wall motion abnormality (RWMA) is considered as another predictors for non-significant coronary artery lesion (P=0.008). Also the angiographic analysis of all lesions revealed that single vessels CAD are the commonest finding in Group I patients (P= 0.02). We further analyzed a suspicious angiographic lesions by using QCA {18 lesions (14.5%)} and FFR {6 lesions (4.8%)} technique.CONCLUSION: Overall, patients with Troponin positive ACS had non- significant coronary artery Stenosis on angiography, and female sex, age <45 years and the absence of diabetes, hypertension, ST- segment elevation or RWMA were all associated with coronary angiography showing no significant stenosis.


Article
Acute Coronary Syndromes in Premenopausal Women: Clinical and Angiographic Findings

Author: Kamel Ashour
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2017 Volume: 16 Issue: 3 Pages: 19-27
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Background: Acute coronary syndromes in premenopausal women isuncommon and limited data is available regarding their risk factor profile and angiographic characteristics.Objectives: To determine the clinical and angiographic findings inpremenopausal women presented with acute coronary syndromes.Patients and methods:Cross sectional study included 160 patients (68premenopausal women and 92 age matched male controls) who were admitted in the coronary care unit of Ibn Al-Betar Center for Cardiac Disease and diagnosed as a cases of acute coronary syndromes between September, 2013 and June, 2014 . The clinical characteristics, angiographic findings for premenopausal women were compared to age matched males.Results: Hypertension was the commonest risk factor for coronary artery disease in both premenopausal women (54.4%) and age matched males (43.5%). The prevalence of smoking was significantly lower in premenopausal women compared with age matched males (8.8% vs 63.0%, p=0.0001). There was no clear risk factor for CAD in 32.4% of premenopausal women (32.4% vs 12.0%,p=0.0006).No significant difference was noted in the prevalence of hypertension (54.4% vs 43.5%, p=0.17), diabetes mellitus (33.8% vs 27.2%, p= 0.36) , dyslipidemia (27.9% vs 35.9%, p=0.29) and family history of CAD (26.5% vs 20.7%,p=0.23) between both groups . Typical chest pain was the presenting symptom in 57.4% of premenopausal women. There was more proximal left anterior descending artery involvement in the premenopausal group (25% vs 17.4%, p=0.02). The rateof angiographically normal coronaries was more in premenopausal women(16.2% vs 9.8%, p=0.045).Conclusion: acute coronary syndrome could be considered in premenopausal women who present with chest pain and careful consideration, examination and diagnosis are essential workup steps in order to not miss this condition.


Article
Current Practice in Management of Acute Coronary Syndrome in Tertiary Iraqi Cardiac Centers

Authors: Mushtaq T. Al-Hassnawi --- Ahmed Hussein AL- Mayali
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2018 Volume: 11 Issue: 2 Pages: 3988-3992
Publisher: Kerbala University جامعة كربلاء

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background There is continued debate as to whether a routine, early invasive strategy is superior to a conservative strategy for the management of acute coronary syndromes.Aim of the study: To verify current practice in the setting of management of acute coronary syndromes in tertiary cardiac centers in Iraq.Patients and methods Four hundred (400) patients were included in this study from 1st of January 2012 to 1st of January 2013from two tertiary Iraqi cardiac centers. Three hundred (300) patients from Ibn Albitar hospital and One hundred (100) patients from Iraqi center for heart disease refered to them as group (A) and group (B) respectively.Results & discussion Mean age for all patients was54.6±9.9 year. In group A there was 208 male patients (69.3%), 92 female patients (30.6%), in group B there was 65 male patients (65%), 25 female patients (25%). Low score (using thrombolysis in myocardial infarction score) found in 166(41.6%), intermediate score in 221 (55.3%), high in 13 (3.3%), no patients with high score was found in group B, mean TIMI score in group A was 1.61±0.5, in group B was 1.60±0.5 (P value NS). In group A UA found in 249 (83%), STEMI in 23 (7.7%), NSTEMI in 28 (9.3%).In group B UA in 79 (79%), STEMI in16 (16%), NSTEMI in 5 (5%) (Pvalue0.02). Smoking is prevalent more in group A (186 patients (62%) versus 43 patients (34%) in group B), while diabetes mellitus and family history of premature coronary artery were more prevalent in group B (Pvalue0.03).All patients in group A with low score were treated medically while in group B with low score treated invasively. Invasive approach was more in group B compared with group A in intermerdiate risk score.Normal coronaries were found in (3.3%) in group A versus (6.8%) in group B. Percutaneous coronary intervention was applied in (66.6%) in group A versus (50%)in group B, surgery used in (23.3%)in group A versus (28.3%)in group B, medical treatment in (10%) in group A versus (21.6%) in group B.There were no statistical difference between both groups regarding duration of admission to hospital and mortality.Conclusion Management of acute coronary syndromes was the same between tertiary cardiac centers and it is progressing significantly in our country.


Article
In hospital outcome and complications of percutaneous coronary intervention in acute coronary syndrome, Gender Differences

Authors: Najah AL-Mosawi --- Amaal N. AL-Marayati
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2008 Volume: 50 Issue: 4 Pages: 420-423
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: women with acute coronary syndrome have increased in-hospital morbidity & mortality as compared with men following percutaneous coronary intervention (PCI). It remains unclear if this difference secondary to the sex or other confounding variables.
Patients and Methods: We sought to examine the characteristics and outcomes of 71 consecutive women (49.2%) and men (50.7) undergoing PCI at The Iraqi Center of Heart Diseases from October 2005 to March 2006.
Results: There were significant differences in the baseline characteristics between both sexes. Women more frequently had SVD(single vessel desiease) (25.7% vs. 16.6%) and 2VD (37.1% vs. 16.6%) while Men were more frequently had 3VD(3 vessel disease) (66.6% vs. 31.4%) P value = 0.05. Women more frequently had LAD lesions (97.1% vs. 83.3%; P=0.05). Men had longer lesion length (13.60±7.75 vs. 12.42±5.12; P=0.03. The outcome of revascularization procedure reveal that the female cohort had a greater incidence of thrombosis (17.1% vs. 2.8% ; P=0.049) and myocardial ischemia (34.2% vs. 13.9%; P=0.044) during procedure and greater incidence of access site hematoma (31.4% vs. 2.7%; P=0.001), hypotension (25.7% vs. 5.6%; P=0.02), non-fatal MI (17.1% vs. 2.7%; P=0.044) and needed more repeated angiography and revascularization (17.1% vs. 5.5%; P=0.0049) during post procedural in-hospital period.
Conclusion: female gender is at greater risk for per procedural and post procedural in-hospital complication, these were not due to female sex itself, but because female have more co morbid diseases and risk factors with smaller body size and smaller blood vessels causing more risky PCI.


Article
Prognostic implications of admission hyperglycemia for in-hospital morbidity and mortality in acute coronary syndrome

Authors: Salim M. AL Ruba'ae --- Ameer A. Oraha
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2010 Volume: 52 Issue: 3 Pages: 249-253
Publisher: Baghdad University جامعة بغداد

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Background: Diabetes mellitus is a well known risk factor for acute coronary syndrome but the hypothesis that patients with acute phase hyperglycemia, regardless the previous diagnosis of diabetes, have worse prognosis than those with normal glucose values is controversial. This paper aims to estimate the prevalence of admission hyperglycemia, its effect on in-hospital prognosis of diabetic and non-diabetic patients with acute coronary syndrome, and to compare it with 2nd day fasting plasma glucose as a prognostic marker.Methods: One hundred patients, (59) diabetic and (41) non-diabetic, with documented acute coronary syndrome enrolled in this study over the period of June/ 2009-Jan./2010 from coronary care unit of Baghdad Teaching Hospital, who were thoroughly examined, hyperglycemia documented on admission and next day, then followed up daily during hospitalization for development of complications or death.Results: Heart failure and recurrent cardiac ischemic events were significantly more common in diabetic than non-diabetic patients (P-value:0.04 for both),while arrhythmias, cardiogenic shock and mortality rate were not significantly different between both study groups.Admission hyperglycemia more than 200mg/dl was associated with higher incidence of cardiogenic shock, recurrent ischemic events, heart failure, and death in non-diabetic patients (P-value 0.009, 0.022, 0.025, 0.026 respectively) but no more arrhythmias, and in diabetic patients admission hyperglycemia was only associated with more recurrent ischemic events (P-value 0.017).Second day fasting plasma glucose more than 126mg/dl was associated with higher incidence of heart failure in non-diabetic patients and more recurrent ischemic events in both study groups.Conclusion: Admission hyperglycemia is a poor in-hospital prognostic marker in non-diabetic & to lesser extend in diabetic patients suffering acute coronary syndrome.


Article
Evaluation of the Complement (C3) in Patients with Acute Coronary Syndrome

Authors: Basil Najeeb --- Ali Hiad --- Ebtsam A. Saleh --- mnther A Tlair Haider --- et al.
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 1 Pages: 40-45
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: To evaluate complement activation (C3) levels in all forms of acute coronary syndrome (ACS) and to find whether there is any significant changes in C3 concentration at the 1st and 4th day after admission and its relation to clinical outcome. OBJECTIVE: Comparing the degree of complement activation (C3 level) between ACS and stable pectoris.To know whether there is any significant difference between the level C3 at first and fourth day. Any correlation between CRP and C3 in patients with ACS. PATIENT AND METHODS: 129 subjects (94 male and 35 female) age range (41-72 years, mean age 57 ± 10.6) were admitted in this study over the period of Feb 2009-Jan 2010 categorized into three groups; 76 patients with acute coronary syndrome (group A), 25 patients with stable angina (group B) and 28 healthy control (group C). Full clinical, biochemical, electrocardiographic and echocardiographic studies liveredone. All patients were followed to the fourth day of admission, Blood samples from peripheral veins were collected centrifuged and Serum C3 levels were measured using immunokit based on single immunodiffusion. RESULTS: The sample of patients was (129) subjects (94 male 72.9%) and (35 female 27.1%). Troponin (I) was positive in 35.7% and negative in 64.3% of the study sample (p. value 0.0005). C-reactive protein (CRP) was significantly correlated with different groups (p. value 0.0004).the same with diabetes mellitus (p. value 0.0003) but not in hypertensive and smokers (p. value 0.486 and 0. 368 respectively).C3levels was significant in correlation to clinical status in both STEMI and NSYEMI 1st and 4th day. Correlation between C3 and C-reactive protein level was insignificant with different groups. CONCLUSION: C3 levels was significantly elevated in correlation between ACS compared to patient with stable angina and healthy control subjects. Also C3 level was significant at the fourth day of admission in patients with NSTEMI in correlation to its level at the first day. However no significance associations between C3 levels and CRP in different studied groups


Article
The Use of Rate of Increase of Intraventricular Pressure During Isovolumetric Contraction (dP/dt) in Assessment of Left Ventricular Function in Acute Coronary Syndrome

Author: Muataz Fawzi Hussein*, Huda Jameel Ibrahim **, Samar I.Essa***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 3 Pages: 324-330
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND:Acute coronary syndrome (ACS) is the clinical manifestation of acutely diminished coronary arterial blood supply. The rate of increase of intraventricular pressure during isovolumetric contraction (left ventricular dP/dt) represents the rate of change of pressure during ejection.OBJECTIVE: The aim of this study is to evaluate the usefulness of the rate of increase of intraventricular pressure during isovolumetric contraction (dP/dt) in assessment of left ventricular function in patients with acute coronary syndrome and its relation to certain clinical and echocardiographic features.PATIENTS AND METHODS:The study is a cross sectional study including 50 patients with an established diagnosis of acute coronary syndrome. The study was performed in Baghdad Teaching Hospital during the period between 2/2/2013 and 5/3/2014. History was taken from all patients and recoded using a specially prepared questionnaire paper. Left ventricular internal dimensions at end diastole (LVIDd) and end systole (LVIDs) were measured using M-mode echocardiography to asses left ventricular systolic function (ejection fraction). Pulse Doppler tracing of the transmitral flow velocities and tissue Doppler image (TDI) mitral annular velocities were obtained from the apical four-chamber view to assess left ventricular diastolic function. Doppler-derived dP/dt was determined from mitral regurgitation (MR) spectral flowRESULTS:The study included 50 patients (31 males and 19 females, mean age of 65.26 ± 5 years). Low dP/dt values were found in 42 patients (84%). Low dP/dt values were found more in the age group (51-60 yrs) (p value < 0.05). The mean age of patients with low dP/dt (<1000) was (65.62 ± 5yrs) and that of patients with normal dP/dt (≥ 1000) was (63.38 ± 5 yrs) with no significant difference (p value > 0.05). Low dP/dt value was significantly associated with smoking and positive family history and not significantly associated with male sex, hypertension, and diabetes mellitus. No significant association was found between low dP/dt value and type of presentation of acute coronary syndrome (p value > 0.05) or ejection fraction (p value > 0.05). It was significantly associated with LV diastolic dysfunction, left atrial size, left atrial pressure, and left ventricular size (p value < 0.05). CONCLUSION:The use of dP/dt is useful for evaluating left ventricular function in patients with acute coronary syndrome.

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