Background: Primary aim of our study to evaluate the safety and feasibility of percutaneous Trans- Ulnar approach for coronary angiogram and intervention.Methods: Patient whom radial pulse was very feeble and difficult to cannulate and having very good volume Ulnar pulse were selected in this study. Total 48(Male 37: Female 11) patients were enrolled in this very preliminary study who underwent elective coronary angiogram (CAG) and subsequent adhoc percutaneous coronary intervention (PCI) in same sitting. Total 11 stents were deployed in 10 territories. Mean ages of male and female were 59 and 52 years respectively. Associated coronary artery artery disease (CAD) risk factors were dyslipidemia, high blood pressure, diabetes mellitus, positive family history of CAD and smoking (all male).Results: Among the study group; 36(75%) were Dyslipidemic, 35(73%) were hypertensive; 34(70.1%) patients were Diabetic, FH 11(23%), and 12(25%) were all male smoker.PCI performed in 9 patients i.e., 18.8% of the total population of this study. Angiographic diagnosis of TVD 8(16.6%), DVD 6(25%), SVD 17 (35.4%), Normal Coronaries 8(16.6%), ISR or patent stent 5(10.4%), Severe Calcified disease 4(12%). Common stented territory was LAD 6(66%), LCX 2(22%) and RCA 2 (22%). Vaso-spasm was not noted as it is quite often in trans-radial approach. Procedural complication like hematoma was not present.Conclusion: We conclude that trans-ulnar approach is a safe, feasible and effective alternative to Transfemoral and Trans-radial approach, specially due to sluggish flow or feeble radial pulsation with severe spasm of radial artery for coronary angiogram and subsequent PCI.Cardiovasc. j. 2018; 11(1): 5-9

Background: Percutaneous Coronary Intervention (PCI) of obstructed & atheromatous venous graft is a real challenge for interventionist to deal with as SVG PCI patients are usually older with significant coronary & non coronary comorbidities. SVG usually presents a degenerated pattern of atherosclerosis with complex friable thrombosis prone lesions, higher risk of distal embolization, poorer long-term outcome with higher ISR rate Objectives: In the current era, with the advent and availability of different Drug Eluting Stents, PCI of SVG vessel is an alternative to re-do surgery for the occlusion of graft vessel. Although, PCI is associated with higher risk of instent restenosis, target vessel repeat revascularization, myocardial infarction or death. Uses of embolic protection devices is class I indication by ACC/AHA for SVG PCI. Therefore, we have carried out this prospective study, to see the outcomes of SVG vessel PCI at our center. Methods and materials: Patients were enrolled in this observational non-randomized prospective cohort, who underwent routine CAG for the post CABG angina, shortness of breath, dyspnea on minimal exertion or hospital admission with MI, NSTEMI, Angina II-III and planned for PCI of occluded graft vessel. Total 50 patients were enrolled in this study. Distal protection devices were not used in most of the cases as financial costing is an issue. Results:Total 46 patients were enrolled in this observational study. Average age of the patient population was (62.1±10.8), female 3(6.5%): male 43(93.5%), BMI (24.9±2.9). Among the CAD risk factors; DM 30(60%), HTN 34(68%), Dyslipidemia 31(62%), Smoking 12(6%) And family history of IHD 9(18%). Graft vessel occlusion occurred average (11.5+5.4 Yrs.) after CABG. SVG to OM is the commonest vessel, that developed significant stenosis in 27(56%), followed by LAD 9(16.1%), RCA 6(10.7%), PDA 6(10.7%), PLB 3(5.4%), DG 3(5.4%)m and LIMA-LAD 1(1.8%). Total 63 stents were deployed in 56 vessels of 46 patients. Double or overlapping stents were deployed; two stents in 11 (17.5%) and three stents in 1 (2%) vessel. One patient had recurrent ISR of SVG-OM stents and had PCI at our center and elsewhere. Common DES were, Sirolimus 25(39.7%), Everolimus 22(34.9%), BMS 9(14.3%), Zotarolimus 3 (4.8%). Average stent size was 3.3mm in Diameter. Total 3 (6%) patient died, in 1 month to 2yrs after the procedure. No acute or late complications were noted in this small group of patients and all were doing well at 12-24 months OPD follow-up. Conclusion: We found that our patients developed graft vessel occlusion on an average 11yrs, after CABG. OM is the commonest territory to develope significant stenosis. PCI of SVG survival outcome was 93.5% (43 patient) in this very primitive observational cohort and all were doing well with OPD follow-up. Thus, we recommend percutaneous coronary intervention of occluded or stenosed graft vessel as an alternative to re-do surgery in this part of the world. Bangladesh Heart Journal 2020; 35(1) : 6-13

Covid-19 pandemic has affected millions of patients, killed more than half a million, and poses major health threat globally. There is high demand for clinical resources and bed space for COVID- 19 patients. Admission of patient of any cardiac emergency in a common block of hospital, country like Bangladesh, may exposes the risk of infection among non-COVID patient. Patient with COVID- 19 and pre-existing cardiovascular diseases (CVD) have increased risk of further aggravation and death. COVID-19 infection is usually associated with multiple direct and indirect cardiovascular complications, such as acute myocardial injury, myocarditis, arrhythmias, heart failure and venous thromboembolism. Health care worker may pose themselves in vulnerability as they become host or vectors of virus transmission. Defeating COVID-19 and managing acute cardiovascular emergencies in COVID-19 era exposes non-COVID-19 patient, may need dramatic reshaping of care delivery, novel approaches to patient’s management and large-scale reallocation of resources. Cardiovasc. j. 2020; 13(1): 75-80

Background: Several studies has shown that impaired renal function might be an important predictor of adverse cardiovascular events in patient with ST elevated myocardial Infarction (STEMI) undergoing primary percutaneous intervention (pPCI). Exact data on clinical impact of baseline or admission serum creatinine level of STEMI patient undergoing pPCI in our patient population not well established. Therefore, we have carried out this non-randomized study to see the effects of S. creatinine level on major adverse cardiovascular outcomes among STEMI patient undergoing pPCI. Methods: Patients were enrolled in this observational non-randomized prospective cohort between November 2017-July 2019, who were presented into our emergency department with acute onset of severe chest pain or angina with ECG evidenced of acute ST elevated myocardial infarction. Total 137 patient (F 12; Male 125) were enrolled in this study. Results: Out of 137 patients, female :12 (8.75%) vs Male: 125 (91.2%). Among, these patient females were more obese (BMI: Female 27.0 ± 2.2 vs male 25.4 ± 4.9) and developed CAD in advance age (Female 59.1 ± 14.5 vs Male 53.4 ± 10.5). Among the 137 patients, 89 (65%) were dyslipidemia, 72 (52.6%) were hypertensive, Diabetic 66(48%), Smoker 70 (51%) and FH positive for CAD were 31 (22.6%). According to the involvement of myocardium infarction, STEMI diagnosis of Anterior MI were 48.9% (n=67) and Inferior MI 51.1% (n=70). An elevated serum creatinine level was defined as creatinine >1.2mg/dl. Based on baseline serum creatinine level, patients were divided into group-A and Group-B. In Group-A. Total 68 patients have S. Creatinine level <1.2 and in Group-B, 69 patients have S. Creatinine level >1.2. Anterior MI were higher in group -B patient than Group-A; Ant MI as 35 (50.4%) vs 31(45.6%), Inf MIL: 34 (49.35) vs 34 (50%), Shock 11 (15.9%) vs 6 (8.8%0, CHB 4 (5.8%) vs 4 (5.9%), Death 12 (17.4%) vs 2 (2.9%) and LVF 5(7.2%) vs 1(1.5%) with 7 days in-hospital stay after primary PCI. Territory wise involvement of vessel in Group-B patient has more involvement of LAD 35 (50.7%) and Group-A has RCA 26(38.2%). Conclusion: In this present study, we found, that in acute STEMI patients, baseline higher serum creatinine level is associated with more AMI related complications and death than in lower serum creatinine level. Thus, we may conclude that baseline admission serum creatinine level may be an important predictor for both in-hospital and 12-month survival outcomes in STEMI patients undergoing pPCI. Cardiovasc. j. 2020; 12(2): 135-142

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