Background: Importance of Physiological study by Fractional Flow Reserve (FFR) in the management of patient with coronary artery disease (CAD is well established.Objective: Angiographic-guided percutaneous coronary intervention (PCI) is a common practice in Bangladeshi interventional era. Data on Pre-PCI physiological study by Fractional Flow Reserve (FFR) in our patient is not available. Therefore, our primary aim was to perform pre-PCI FFR to assess the angiographically significant coronary stenosis and thus to avoid inappropriate stenting.Methods: Total 22 patients (Male 20, Female 2) were enrolled in this observational non-randomized prospective cohort. Patient who had angiographically significant lesion, planned for physiological study by pre-PCI FFR. Cut off value for FFR were clinically significant only if Pd/Pa ratio <0.75 and differed stenting if > 0.76-0.80 or above. 67%(18), LCX 14.8%(4), RCA 14.8%(4) and Ramus Intermedius 3.7% (1). FFR was nonsignificant (<0.75) in 59% (13) patients and significant (>0.75) were in 41%(9) patients. Results: In the studied patient population, FFR done in total 27 vessels of 22 patients. Among the vessel wise FFR distribution were in LADConclusion: In this single center, very preliminary observational prospective cohort of non-randomized study, we found, that FFR is an important aid to perform PCI in patient with angiographically significant coronary lesion, and to avoid inappropriate stenting of insignificant stenosis by physiological study. Thus, to reduce cost and untoward effects of inappropriate stenting.

Background: Dual antiplatelet (DAPT) treatment with Clopidegrol and Aspirin after percutaneous coronary intervention(PCI) is common practice for the interventionist to prevent thrombotic event after coronary stent placement. In spite of this, significant number of thrombotic events still occur. Exact data on our population regarding the thrombotic events after successful PCI and uses of DAPT not yet available. Therefore, we have carried out this study to see sensitivity resistance in our population by measuring Clopidegrol resistance test (CYP2C19 assay). Methods: Total 351 patients were enrolled in this observation non randomized prospective cohort. Patient who had percutaneous coronary intervention (PCI) at our center or elsewhere, and on Clopidegrol with Aspirin, were selected for the study. Clopidegrol resistance were measured by PCR assay for CYP2C19 at our hospital molecular lab. Results: Among the 351 patients, male 292 and female 59. Average age for the male: female was 59:61years. Clopidegrol resistant test was performed by Real Time PCR for CYP2C19. Total 57%(200) patients are Clopidegrol resistant or positive and 43%(151) patients are Negative. Among the resistant case 9.1%(32) patients are Homozygous Positive with probable genotype CYP2C19*2 (*2/*2) and 168 (47.8%) patients were Heterozygous positive with probable genotype CYP2C19(*1/*2). Among the CAD risk factors, Dyslipidemia were more, followed by HTN, DM, FH and smoking. Among the studied group; PCI territory Left Anterior Descending (LAD), total number of Percutaneous Coronary Intervention (PCI) and number of vessel that is Single Vessel Disease (SVD) were more in Heterozygous, Homozygous and CYP2C19 Negative group. Conclusion: In this single center, observational prospective cohort, we found quiet a significant (57%) number of patients are Clopidegrol resistant. Therefore, we may need to double the Clopidegrol dose and or to start other antiplatelet such as Ticagrelor or prasugrel in addition to Aspirin. Thus, to prevent stent thrombosis or restenosis. Cardiovasc. j. 2019; 12(1): 45-52