Contrast Induced Nephropathy in Post PCI Patients at an Indian Tertiary Care Institute | Medicine and Medical Research: New Perspectives Vol. 1

 

Aims: This observational investigation aimed to determine the incidence of contrast-induced nephropathy and the factors predicting its development after Percutaneous Coronary Intervention at our Institute.

 

Materials and Methods: The study included 520 patients who underwent Percutaneous Coronary Angioplasty within a one-year period at our institution and met the inclusion criteria. Renal parameters, including serum Creatinine and Blood Urea levels, were assessed at baseline, 24 hours, and 48 hours post-procedure. Contrast-induced nephropathy was defined as a >25% increase or >0.5 mg/dl rise in pre-catheterization serum creatinine at or after 48 hours following the intervention after other causes of renal impairment had been excluded.

 

Results: In the study, 67 patients (12.88%) developed Contrast-induced Nephropathy post-PCI which was in line with previous studies on this matter. Advanced age, diabetes mellitus, hypertension, and anaemia were identified as significant predictors of CIN. Moreover, higher contrast volume and elevated baseline creatinine levels were associated with an increased risk of CIN.

 

Conclusions: The occurrence of CIN is a recognized complication of PCI which leads to increased mortality and morbidity and the high cost of managing such patients, which can largely be mitigated through the identification of patients with predisposing factors and the implementation of preventive measures in accordance with guideline recommendations.

 

Author(s) Details

Cinosh Mathew
Department of Cardiology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth (Deemed to be University), Piparia, 391760, Vadodara, Gujarat, India.

Rachit Saxena
Department of Cardiology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth (Deemed to be University), Piparia, 391760, Vadodara, Gujarat, India.

Aseem Yadav
Department of Cardiology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth (Deemed to be University), Piparia, 391760, Vadodara, Gujarat, India.

Abhishek Gupta
Department of Cardiology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth (Deemed to be University), Piparia, 391760, Vadodara, Gujarat, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v1/1434

Anomalous Origin of Coronary Arteries from Opposite Situs and the Conundrum of Sudden Death Pathophysiology: Insights from Interventional Cardiology| Chapter 12| Medicine and Medical Research: New Perspectives Vol. 5

 

An anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus, with an interarterial course, has been associated with an increased risk of myocardial ischemia and sudden death. The prevalence of coronary artery anomalies in patients undergoing coronary angiography ranges from 1% to 5% [1]. This variation depends on the population studied and the definitions used to categorize the anomalies. Their detection is crucial due to their potential to cause life-threatening events. As the exact pathophysiology of AAOCA is not well understood, the clinical management is also not well defined. With the increased use of non-invasive imaging, the diagnosis of AAOCA is increasing and the association of anomalous origin and atherosclerotic disease is becoming a more important topic.

 

Several studies have been done to find a true “denominator” causing ischemia and sudden cardiac death (SCD). The pathophysiological mechanisms taken into account include ischemia caused by mechanical compression exerted on the artery tract with an abnormal course, its geometric alterations (including a slit-like ostium, acute take-off angle, and proximal narrowing) and histopathological changes in the vessel wall.

 

This chapter is given as an example of a rare case of AAOCA chronic total occlusion (CTO). A 40-year-old Caucasian man was referred for invasive coronary angiography (ICA) due to typical chest pain and positive myocardial scintigraphy. ICA demonstrated CTO of an anomalous right coronary artery (ARCA) originating from the left side of the ascending aorta with an interarterial course. During the procedure, an unexpected rupture of the coronary artery occurred after dilatation with a small balloon at low pressure. The complication was an opportunity for food for thought. Coronary artery perforations are rare but life-threatening procedural complications that are usually caused by predisposing anatomical and procedural factors. Based on this complication, this study hypothesized that the arterial wall might be fragile due to pathological alterations, potentially contributing to the pathophysiology of coronary malignancy. Recent studies conducted on small samples have shown the presence of histopathological alterations (such as elastic fiber alterations, mural fibrosis, and smooth muscle disarray) in patients with anomalous aortic origin of a coronary artery [2]. However, further autopsy studies, including larger samples, are needed to understand the histopathological changes associated with coronary anomalies and an increased risk of SCD.

 

Author (s) Details

Cocco N.
Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128, Rome, Italy.

 

Gelfusa M.
Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128, Rome, Italy.

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v5/1790

Anomalous Left Circumflex Artery: Insights and Challenges in Primary Percutaneous Intervention (PCI) | Chapter 13 | Medical Science: Trends and Innovations Vol. 3

Congenital coronary anomalies are rarely found in patients undergoing diagnostic coronary angiography (0.2% - 1%). These anomalies cause difficulty in the early identification of the culprit anomalous artery and complicate the engagement of the affected vessel especially in a Primary percutaneous coronary intervention (PCI) when time is of the essence and rapid reperfusion is warranted. This case report discusses a 56-year-old male patient who presented with an Acute Inferior Wall Myocardial Infarction. While undergoing a diagnostic coronary angiogram, an occluded left circumflex artery (LCx) was discovered, which arose anomalously from the right coronary ostium. Primary percutaneous coronary intervention (PCI) of the LCx could not be performed using standard guide catheters, necessitating a specialized multipurpose guide catheter with balloon support. This case underscores the importance of understanding coronary architecture, the anomalous origins of coronary arteries, and the necessity for selecting appropriate guiding catheters and coronary wires.

 

Author (s) Details

 

Cinosh Mathew
Department of Cardiology, SBKS Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Piparia, Vadodara, Gujarat, India and B-17, Saket Society, Behind Essar Petrol Pump, Sussen-Tarsali Road, Vadodara-390009, Gujarat, India.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/msti/v3/4140

Determining the Role of Serum Cystatin C in the Early Detection of Contrast-Induced Nephropathy after Coronary Intervention | Chapter 6 | New Horizons in Medicine and Medical Research Vol. 12

Contrast-induced nephropathy is the most frequent side effect of both coronary angiography (CAG) and percutaneous coronary intervention (PCI) (CIN). The current study's objective is to determine if serum cystatin C can be utilised to diagnose CIN 24 hours following elective CAG and/or PCI in individuals.

The research included 80 participants with elective cardiology (48 males, 32 females). The study was conducted in Holy Karbala, Iraq, in the heart catheterization lab of the Al-Hussein Medical City/ Karbala Health Directorate. Blood urea, estimated GFR, serum cystatin C, and serum creatinine are among the laboratory and clinical tests that are performed.

19 patients (23.8 percent) with renal impairment ranging from grade 0 to 2 had contrast-induced nephropathy. Serum creatinine, cystatin C, and eGFR all rose considerably (p0.001, 0.01 correspondingly) after angiography/angioplasty operations for 24 hours. Creatinine had a greater area under the curve (p=0.001), 78.9% sensitivity, and 60.7 percent specificity than serum cystatin C (95 percent CI=0.673-0.881), according to a receiver-operating characteristic analysis. P=0.001, sensitivity=78.9%, specificity=64%, and a cystatin C threshold level of >7 ng/ml. A reliable biomarker for early detection of contrast-induced nephropathy was cystatin C.

Author(s) Details:

F. J. Al-Tu’ma,

Department of Biochemistry, College of Medicine, University of Kerbala/ Holy Karbala, Iraq.

M. H. Dheyauldeen,

Department of Biochemistry, College of Medicine, University of Kerbala/ Holy Karbala, Iraq.

M. A. Al-Mukhtar,

Center of Radiology, Holy Karbala, Iraq.

S. Y. Al-Jawad,

Center of Cardiology, Holy Karbala, Iraq.

R. M. Al-Saegh,

Department of Nephrology, College of Medicine, University of Kerbala/ Holy Karbala, Iraq.

Please see the link here: https://stm.bookpi.org/NHMMR-V12/article/view/7272

Inflammatory Response to Percutaneous Coronary Intervention | Book Puiblisher International

 Atherosclerosis is currently thought to be an inflammatory condition. Inflammation has been shown to play a role in both the beginning and course of the disease. Coronary artery disease is the world's biggest cause of death. Percutaneous coronary intervention, which is still the subject of intense study and development, has revolutionised the treatment of coronary artery disease. Percutaneous coronary intervention causes a large inflammatory response in the wounded artery wall, which might lead to neointimal thickening and restenosis. Balloon coronary angioplasty or stent placement is linked to considerable platelet activation, which enhances leukocyte migration to the damaged artery wall and has also been linked to an inflammatory response. Through neointimal proliferation, inflammation plays a key role in defining stent restenosis. This inflammatory process has been linked to a number of acute-phase reactants, cytokines, and soluble cellular adhesion molecules. Furthermore, atherosclerotic disorders such as unstable angina pectoris, acute myocardial infarction, and angiographically confirmed coronary heart disease have been linked to higher inflammatory protein levels in the peripheral blood. As a result, large levels of acute phase reactants are linked to a poor prognosis.

Conclusion: Percutaneous coronary intervention causes a large inflammatory response in the wounded artery wall, which leads to neointimal thickening and restenosis. Post procedural inflammatory response in patients undergoing coronary intervention reveal a wide range of mechanisms, including mechanical disruption of atherosclerotic plaque, arterial wall injury, myocardial necrosis due to distal embolization and endothelial dysfunction, and release of inflammatory factors followed by leukocytes and platelet activation along with the ischaemiareperfusion injury. Anti-inflammatory treatments may be useful in reducing in-stent restenosis since the inflammatory response has an equal role in neointimal development following coronary stenting as arterial damage.

Author(S) Details

Najah R. Hadi
Faculty of Medicine, University of Kufa, Iraq.

Bashaer M. Muhammad-Baqir
Faculty of Pharmacy, University of Kufa, Iraq.

Mustafa H. Ahmed
Al-Sader Teaching Hospital, The Specialist Centre for Nephrology and Kidney Transplantation, Iraq.

View Book:- https://stm.bookpi.org/IRPCI/article/view/4998