Objective: The research aimed to examine the relationship between kidney dysfunction and the occurrence of slow blood flow or no-reflow phenomenon and insufficient ST-segment resolution after the percutaneous coronary intervention procedure in individuals suffering from ST-elevation myocardial infarction. Methods: In a retrospective analysis conducted at Hayatabad Medical Complex Peshawar, for six months, 210 consecutive patients have undergone percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). The term slow-flow/no-reflow referred to an angiogram result of TIMI Grade <3 after the implantation of a stent, despite a residual stenosis of less than 50%, and with no major damage or visible blood clots. Results: The study included 210 patients, with 185 (88.0%) having normal flow and 25 (11.9%) having slow flow/no-reflow after PCI. Comparison between patients with normal flow and those with slow flow or no-reflow. Male sex was more common in the LVEF ≥50% group compared to the LVEF <50% group (84.2% vs. 74.0%, p=0.043). Practical Implication: Overall, the practical implications of this study can positively impact the community by enhancing risk assessment, patient management, treatment approaches, communication, and future research in the context of renal dysfunction and PCI outcomes in STEMI patients. Conclusion: The study found that patients with STEMI who have renal dysfunction are more likely to experience SFR and ISR after undergoing PCI. We should regard renal dysfunction as a significant factor that increases the risk of these complications. Treatment may need to be more intensive to achieve better results in these patients. Keywords: Renal dysfunction, slow-flow/no-reflow phenomenon, inadequate ST-segment resolution,

Objectives: The objective of this study was to determine the frequency of non-compliance to treatment and common precipitating factors in stage C heart failure (HF) patients at a tertiary care cardiac hospital of Karachi, Pakistan. Methodology: This descriptive cross-sectional study was conducted at a tertiary care cardiac center of Karachi, Pakistan. Required number of consecutive patients of either gender between 18 to 75 years of age who were diagnosed with stage C HF were included in this study. Data for the study were collected on a pre-defined proforma consisted of demographic characteristics (gender, age), clinical factors, and precipitants of decompensation of HF (duration of disease, non-compliance to the treatment, infection, arrhythmias, uncontrolled hypertension, and anemia). Results: A total of 114 patients with stage C HF were included. Mean age was 56.7 ± 9.9 years with 34.2% (39) patients above 60 years of age. Male patients were 51.8% (59) of the total sample and median duration of disease was 36 [20 to 60] months. Non-compliance to the HF treatment was observed in 48.2% (55), while among other precipitants, infection was observed in 21.9% (25), arrhythmias in 20.2% (23), uncontrolled hypertension in 13.2% (15), and anemia in 18.4% (21). Conclusion: A significant proportion of stage C HF patients were found to be non-adherent to the prescribed treatment. The most commonly observed triggering factor was infection followed by arrhythmias. Routine practice must include an ongoing assessment of compliance to the treatment and lifestyle modifications among HF patients for the proper counseling of non-complying individuals.

Background: Coronary slow flow phenomenon (CSFP) and coronary no-reflow phenomenon (CNP) have the potential to raise the risk of severe cardiovascular adverse events (MACE). Objectives: This study's goal was to evaluate and contrast the clinical outcomes after a year for CNP and CSFP patients who received PCI for a non-ST elevation myocardial infarction (NSTEMI). Methods: In this research, 95 patients had NSTEMI and had PCI within 24 hours after symptoms started. An angiographic characteristic of the infarct-related artery's TIMI flow was used to divide patients into two groups: the CSP group (n=85) and the CNP group (n=10). Patients were tracked for a full year. To be statistically significant, the p-value needed to be <0.05. Results: There were 95 patients with NSTEMI included in this research (66 males; mean age: 62.71±13.70). CNP was seen in 10.5% (n = 10) and CSFP in 89.4% (n = 85) of NSTEMI patients, respectively. we provide the results of our demographic analysis. Conclusion: When comparing CNP and CSFP patients with NSTEMI, the clinical results and risk of stroke are worse for CNP individuals. Keywords: Coronary no-reflow Phenomenon, Slow-Flow Phenomenon, non-ST-elevation myocardial infarction.

Objective: To determine the prevalence of significant left main coronary artery disease (Stenosis more than 50%) at NICVD Karachi. Method: We conducted this observational cross-sectional study retrospectively at NICVD Karachi. Our institution analyzed both emergency and elective coronary angiography data from 5th July 2018 to 5th July 2020 for the existence of significant left main coronary artery disease. A study of coronary artery disease only included patients with significant left main coronary artery disease. Approximately 50% stenosis was considered significant left main coronary artery disease. Results: A total of 10,828 patients were selected for the study population, out of the total of 8975 males and 1853 female patients who underwent coronary angiography during our mentioned period at NICVD Karachi, 327 patients (3%) showed significant left main coronary artery disease. 277 patients (83%) were male and 50(17%) were female. About 50% of patients were between the ages of 60 -80 years old Minimum age was 32 years and the maximum age was 95 years. Hypertensive were 5197 (48%) and diabetes was 2480 (22.9%). The maximum number of patients in CCS grade II angina is about 239 (73.0%). Conclusion: High prevalence of disease in the Left major coronary artery is associated with greater mortality and morbidity in our CAD patients. Keywords: Coronary artery diseases, left main coronary artery, coronary intervention, coronary angiography

Objectives: To characterize the clinical demonstration, risk factors, echocardiographic, and coronary angiographic profile of very young individuals presenting with their first AMI at a tertiary care hospital at NICVD Karachi Sindh, Pakistan Background: Rare cases of acute coronary syndrome (ACS) occur in relatively young persons under the age of 30. In Pakistan, <2% of people have experienced an acute myocardial infarction (AMI). When it happens at this young age, ACS has a substantial impact on the patient's psyche, morbidity, and increased financial burden. Single-vessel disease and non-obstructive stenosis are considerably more common in young individuals with ACS on coronary angiography (CAG). Materials and Methods: At the Department of Cardiology NICVD Karachi, this retrospective observational research was carried out. Very young individuals (≤30 years of age) who had their first AMI from 1st January to 30th June 2019 had their medical records gathered and examined. Results: 50 young patients aged ≤30 years old were hospitalized with their first AMI. The majority of the patients were between the ages of 25–30 years. Patients had a mean age of 28.62 ± 2.04 years, and 48 of them (96%) were men. Smoking was the most frequent risk factor for CAD, accounting for 54% of cases in individuals under the age of 30. One patient presented with a complete heart block and a temporary pacemaker was inserted as a lifesaving measure. STEMI (78%) was more common as compared to NSTEMI (22%). The mean left ventricular ejection fraction was 41.4±7.6%. The single-vessel disease was the most prevalent (60%) finding. The most common culprit vessel was the LAD artery (40%) followed by the RCA (14%). The double-vessel disease was seen in 22% of individuals and the most common combination of vessels was LAD and RCA (14%). Conclusion: When compared to older patients, very young individuals showed less severe CAD, which is probably because their coronary arteries had less atherosclerosis. Smoking and dyslipidemia are the most avoidable risk factors in Pakistan's youthful population. Primary prevention, such as public awareness campaigns about the dangers of smoking, poor eating habits, and sedentary lifestyles, may assist to avert the emergence of cardiac issues in later life. Keywords: Acute coronary syndrome, coronary artery disease, smoking, young adults