Background and Aim: Patients with acute coronary syndrome who receive radial access by percutaneous coronary intervention (PCI) are less likely to experience clinical adverse events. The present study aimed to associate the PCI procedural time with left subclavian artery angle in acute coronary syndrome patients. Material and Methods: This retrospective study was carried out on 124 consecutive patients who underwent percutaneous coronary intervention in Punjab Institute of Cardiology, Lahore from June 2021 to June 2022. Prior to study conduction, the ethical committee approved the study protocol. After a CT scan on admission, patients with PCI via an LRA were included in this study. The angle of left subclavian artery was measured on CT scan through coronal view as an indicator for tortuosity and was related with procedural time and clinical variables. SPSS version 26 was used for data analysis. Results: Of the total 124 consecutive patients who underwent PCI, the left radial approach was used in 60 (48.4%) acute coronary syndrome patients. The overall mean age was 64.8±12.6 years. There were 37 (29.8%) females and 87 (70.2%) males. Severe tortuosity patients (left subclavian artery angle <70 degree) had higher incidence of female gender (41.6% vs. 14.2%, p<0.001), older age (73.8±9.87 vs. 59.6±14.2 years, P<0.005), higher subclavian artery calcification (72.6% vs. 32.8%, P=0.001), and hypertension (92.6% vs. 74.8%, P<0.01) than those with angle of left subclavian artery ≥70 degrees. Total procedural time (ρ=-0.29, P=0.003), and sheath cannulation to first balloon time (ρ=-0.48, P<0.001) were negatively associated with left subclavian artery angle. Conclusion: The present study found that Left subclavian artery lower angles are indicators of tortuosity via left radial approach significantly associated with total procedural time and sheath insertion long duration to the first balloon time during percutaneous coronary intervention. Keywords: Acute coronary syndrome, Percutaneous coronary intervention, left radial access

Background :One of the most serious side effects of percutaneous coronary intervention (PCI) for bifurcationlesions is major side branch (SB) blockage. PCI is used to treat coronary bifurcations lesions inabout 15-20% of cases. Because of the risk of SB compromise, PCI of coronary bifurcationlesions is frequently thought to be a difficult procedure.OBJECTIVE: The goal of this study was to investigate the clinical and lesional predictability ofsevere SB blockage during coronary bifurcation intervention.MATERIAL & METHODS: It was a retrospective study performed at Cardiac CatheterizationLab, Punjab Institute of Cardiology, Lahore. It was a six months study from 15th April 2022 to14th Oct, 2022. 93 patients enrolled using non-probability sampling technique. Patients betweenthe ages of 30 and 70 of either gender, with coronary bifurcation lesions undergoing PCI and atleast one significant SB were included. Data was entered in the predesigned proforma. SPSSversion 24 was used to analyze our data.RESULTS: In our study a total of 93 patients were enrolled, the mean age of the cases was53.30 ± 1.12. There were 68 (73%) male and 25 (27%) females in our study. There were 52(56%) diabetic, 50 (54%) hypertensive, 63 (68%) smokers and 42 (45%) hypercholestrolemicpatients were present in our study. In our study 36 (39%) patients were found with family historyof CAD and 6 (7%) patients found with recent MI. LAD was most frequently utilized bifurcationlesion in our study. The mean of lesion length was 28.82 ± 10.91 in this study. SB angle was 41º-50º in most of the cases 20 (22%), side branch diameter stenosis post MV stenting was 70-75%in 40 (43%) cases. Medina classification 1,1,1 was found in 43 (46%) cases. In 62 (67%) casesno side branch jailing was observed. Side branch predilatation before MV stenting was found in72 (77%) cases. Need of stenting in SB was found in 60 (65%) cases. Most frequently usedtechnique for SB provisional stenting was DK crush and mini crush in this study.Keywords: Bifurcation Lesions, SB, PCI

Background: contrast-induced nephropathy (CIN) is the most common complications associated with contrast media after angiographic procedures. The therapeutic intervention for CIN after the procedure, to date, is not yet conclusive. Therefore, the main reliance for the management of CIN is considered to be adequate assessment of risk-benefit and the preventive strategies. A little research has been done to identify the predictors of CIN in Pakistan. Objective: To assess the incidence and the predictors of CIN in our setting. Methodology: A total of 120 patients of Punjab Institute of Cardiology, Lahore who underwent primary PCI during January to July 2022, were observed to CIN through cross-sectional observational study. The baseline and some postprocedural laboratory findings, angiographic and interventional characteristics were observed on a pre-formed Performa and the data was analyzed using SPSS. Logistic regression analysis was implied to assess the independent predictors of CIN. Results and conclusion: CIN developed in 15% of the patients. LVEF, admission blood glucose, haemoglobin, eGFR, and contrast volume greater than 100 ml were all shown to be linked with CIN in univariate analysis. Age, eGFR, admission serum glucose, diabetes mellitus, and contrast volume more than 100 ml were shown to be independent predictors of CIN in the study participants.

Background: Greater first medical contact to device time has been observed to adversely effects the outcome of primary PCI. European Society of Cardiology (ESC) recommends a maximum of 90 min delay in FMC to device time. However, the effect of the FMC to the device time on the myocardial reperfusion (TIMI blush grade) is not assessed yet. Objective: To investigate the effect of the FMC to the device time on the TIMI blush grade of the STEMI patients who underwent primary PCI. Methodology: It was a prospective study consisting of 445 STEMI patients of Punjab Institute of Cardiology, Lahore, fulfilling the entry criteria in this study in the time period from January 2020 up to January 2022. The patients were divided into two study groups: those with FMC-D interval of < 90 min or short group and those with FMC-D interval of ≥ 90 min or the long group. TIMI blush grade was taken as the primary clinical endpoint whereas MACE at the 30 day follow up were taken as the secondary endpoints. Comparison of the clinical and peri-procedural outcomes was done among the two groups by SPSS. Results: The mean FMC-D time was 77.3 ± 32.1 minutes in short FMC-D time group and 117.1 ± 12.5 minutes in long FMC-D time group (p < 0.01). At the duration of 30 days, individuals in the long group showed significantly higher rates of MACE (14.2% vs 3.9%, p = 0.0002). Higher cardiac death rate was the driving force behind the noted difference (7.1% vs 1.2%, p = 0.002). Conclusion: First medical contact to device time does not significantly impact the final TIMI blush grade in patients underwent PCI. Patients in whom the delay of treatment is < 90 minutes have significantly lower rates of MACE at the 30 days duration. Keywords: First medical contact, TIMI blush grade, PCI, STEMI, FMC-D time.

Background and Aim: In-stent restenosis (ISR) in coronary artery disease patients can be effectively treated with drug-eluting ballons (DEB). Yet, the prevalence and binary restenosis related factors have not been assessed in the past. The present study intended to determine the incidence and outcome predictors in drug-eluting ballons treatment of in-stent restenosis. Methods: This retrospective study was carried out on 152 coronary artery disease patients in Punjab Institute of Cardiology, Lahore from January 2021 to July 2022. Prior to study conduction, the research and ethical committees approved the procedure. Patient’s demographic details, clinical characteristics, laboratory tests, and lesion features were recorded. Data analysis was done in SPSS version 26. Results: Of the total CAD patients, 110 (72.4%) were male and 42 (27.6%) were females. The overall mean age was 56.82±4.56 years. The prevalence of different risk factors for cardiovascular disease such as diabetes, hypertension, smoking, LDL >1.40 mmol/l, and family history was 82 (53.9%), 94 (61.8%), 92 (60.5%), 64 (42.1%), and 16 (10.5%) respectively. Other comorbidities such as chronic kidney disease and heart failure were present in 58 (38.2%) and 12 (7.9%) respectively. High-dose statin therapy was given to 40 (26.3%) patients. The occurrence of MACEs, myocardial infarction, targeted vessel revascularization (TVR), and target lesion revascularization (TLR) during follow-up was 56 (36.8%), 40 (26.3%), 10 (6.6%), and 33 (21.7%) respectively. The mortality rate was 13 (8.6%). Multivariate logistic regression were used to identify the independent factors such as diffuse ISR [OR=2.21: CI 95%, (1.2-1.76), stents ≥2 per lesion [OR=1.78; 95% CI (1.12-2.19)], proximal left anterior descending artery [OR=1.31; 95% CI (1.2-1.76)], and triple vessel disease [OR=2.87, 95% CI (1.1-6.3), p=0.005)]. Conclusion: The present study concluded that In-stent restenosis is a coronary angioplasty serious complication with adverse outcomes. For in-stent restenosis, drug-eluting balloons are an effective alternative to stenting. MACE was shown to be prevalent in our data. MACE is a measure of all-cause mortality in a high-risk group and demonstrates that DEB provides both short-term and long-term advantages in ISR. Keywords: In-stent restenosis, Drug-eluting ballons, Predictor outcomes.