STUDY POPULATION:
Adult patients >18 yrs. of age with the diagnosis of CAD , undergoing Angiography in Department of Cardiology Government Rajaji Hospital
CASES:
Inclusion criteria:
- Age ≥18 years with diagnosis of CAD ( both Stable Ischemic Heart disease and Acute Coronary Syndrome)
- Patients having obstructive CAD, Coronary artery Ectasia and/or Coronary artery aneurysm in Coronary angiography
Exclusion criteria:
1) Age <18yrs
2) Patients already undergone PTCA ,CABG
3) Pre-existing valvular heart disease
4) Pre-existing cardiomyopathies
5) Pre-existing Arrhythmias
7) Concomitant acute or chronic kidney disease
8) Vasculitis (Kawasaki disease ,Takayasu arteritis)
Methods
From the study population after obtaining informed written consent detailed history were taken .Demographic and personal and health information were collected from the patient . Blood samples were collected for laboratory investigations to assess the conventional and novel risk markers like Neutrophil Lymphocyte Ratio (NLR)Mean platelet volume( MPV) ,Red Cell Distribution width (RDW)
Definition of risk factors.
Diabetes Mellitus (DM):
Diabetes Mellitus was diagnosed
- If a patient is already on oral hypoglycemic drugs or on Insulin therapy
- If a patient has symptoms of DM
Plus
Random Blood sugar of > 200 mg/dl or
Fasting blood sugar >126mg %
Systemic Hypertension :
A patient was diagnosed to have hypertension
1. If he is on antihypertensive therapy
2. If his BP is >140/90 mm of Hg on presentation and on repeat recording
(>2 occasions)
Lipid abnormality :
If a patient has
- Elevated LowDensityLipoprotein(LDL) cholesterol >100 mg%
- High Triglycerides (TGL) >150 mg%
- HighDensityLipoprotein (HDL) cholesterol < 35 mg /dl
Any patient with Body Mass Index (BMI)> 30 kg/m2 was labelled as obese
Definition of Acute Coronary Syndrome :
Myocardial infarction (MI)was defined as per Universal definition of MI [i] Diagnosis of Unstable angina was made if a patient fulfil any of the following criteria [ii]
Coronary Angiography :
After obtaining an informed written Coronary angiography was done through either right femoral artery or right radial artery approach after sterile aseptic precaution under local anaesthesia using Judkins right and left (JR ,JL ) coronary catheter . 4 or 5 views for LAD( RAO caudal , AP caudal ,AP cranial ,LAO caudal ,LAO cranial) and 2 or 3views for RCA LAO ,AP cranial LAO cranial were recorded .The films were reviewed by junior resident and findings were confirmed by experienced interventional cardiologist
Definition of Ectasia :
In our study we followed the definition used in CASS registry abnormal dilatation of coronary artery, with luminal diameter exceeding 1.5 times the adjacent normal reference segment. If no adjacent normal segment could be identified, the mean diameters of the coronary segments in a control group without heart disease served as normal values.”
Definition of obstructive CAD in angiogram :
Obstructive CAD was diagnosed if a patient had > 50% loss of luminal diameter compared to the reference normal segment.
Definition of Groups:
According to the angiography patients were categorized into three groups Group A = Isolated Ectasia patients having Ectasia without any evidence of significant obstruction in coronary artery (>50%), Group B Mixed CAE + CAD group Patients with Ectasia and also having significant obstruction in any of the coronaries .Group C= Pure CAD group patients having only CAD without evidence of CAE
Patients were treated according to the guideline given by American College of Cardiology /American Heart Association . Left ventricular systolic function was recoded with Philips IE 33 echocardiography machine . Clinical events LVF ,in hospital mortality were recorded . Outcome data during follow up were collected specifically regarding the Unstable angina ,MI mortality and recoded for analysis
Stastical Analysis ;
Continuous variables were analyzed with Mean ± SD (BMI, Lipid parameters ,age) . Categorical variables sex ,DM hypertension ,vessel involved outcome ) were described with number & percentage .Chi Square test used to assess the significance P value < 0.05 were considered as stastically significant.