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Khan KA, Qamar N, Saghir T, Sial JA, Kumar D, Kumar R, Qayyum D, Yasin U, Jalbani J, Karim M. Comparison of Intracoronary Epinephrine and Adenosine for No-Reflow in Normotensive Patients With Acute Coronary Syndrome (COAR Trial). Circ Cardiovasc Interv 2022; 15:e011408. [PMID: 35000456 PMCID: PMC8843359 DOI: 10.1161/circinterventions.121.011408] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Intracoronary epinephrine has been effectively used in treating refractory no-reflow, but there is a dearth of data on its use as a first-line drug in normotensive patients in comparison to the widely used adenosine. Methods: In this open-labeled randomized clinical trial, 201 patients with no-reflow were randomized 1:1 into intracoronary epinephrine as the treatment group and intracoronary adenosine as the control group and followed for 1 month. The primary end points were improvement in coronary flow, as assessed by TIMI (Thrombolysis in Myocardial Infarction) flow, frame counts, and myocardial blush. Secondary end points were in-hospital and short-term mortality and major adverse cardiac events. Results: In all, 101 patients received intracoronary epinephrine and 100 patients received adenosine. Epinephrine was generally well tolerated with no immediate table death or ventricular fibrillation. No-reflow was more effectively improved with epinephrine with final TIMI III flow (90.1% versus 78%, P=0.019) and final corrected TIMI frame count (24±8.43 versus 26.63±9.22, P=0.036). However, no significant difference was observed in final grade III myocardial blush (55.4% versus 45%, P=0.139), mean reduction of corrected TIMI frame count (−25.71±11.79 versus −26.08±11.71, P=0.825), in-hospital and short-term mortality, and major adverse cardiac events. Conclusions: Epinephrine is relatively safe to use in no-reflow in normotensive patients. A significantly higher frequency of post-treatment TIMI III flow grade and lower final corrected TIMI frame count with relatively better achievement of myocardial blush grade III translate into it displaying relatively better efficacy than adenosine. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04699110.
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Affiliation(s)
- Kamran Ahmed Khan
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Nadeem Qamar
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Tahir Saghir
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Dileep Kumar
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Rajesh Kumar
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Danish Qayyum
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Umamah Yasin
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Javed Jalbani
- Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- Department of Clinical Research (M.K.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Kumar D, Yasin U, Saghir T, Akbar Sial J, Khatti S, Khan K, Khan N, Naeem Mengal M, Qamar N. Statin induced myalgia on high intensity statin in patients with Acute Coronary Syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
High intensity statins are recommended in patients with acute coronary syndrome. Statins inhibit atherosclerotic plaque formation in the coronary arteries and reducing the burden of ischemic heart disease, therefore decreasing the morbidity and mortality. Muscle symptoms are most common adverse effect of statins. Hence, the aim of this study is to determine the statin induced myalgia by the statin myalgia clinical score.
Purpose
To monitor the Statin induced myalgia on high intensity statin in patients with Acute Coronary Syndrome
Methods
This was an prospective observational study comprised of 418 patients with acute coronary syndrome who were commenced on high intensity statins (Rosuvastatin 20–40mg & Atorvastatin 40–80). These patients were followed at 4 weeks, 8 weeks and 12 weeks subsequently and the clinical myalgia score (SAMS-CI) was calculated at each visit to determine the statin induced myalgia. SAMS-CI was categorized as unlikely (2–6), possible (7–8) and probable (9–11)
Results
From 418 patients, 327 were males and 91 were females. Mean age was 55.6±11.14. Only 19 (7.63±1.8) patients developed muscle symptoms on high intensity statins (Rosuvastatin 20 mg and Atorvastatin 40 mg) on SAMS-CI Score. 5 patients were unlikely to develop myalgia on SAMS-CI and continued with the same dosage without any new symptoms. 6 patients were possible on SAMS-CI, therefore the dosage of these patients were decreased to moderate intensity statin (Rosuvastatin 10mg, Atorvastatin 20 mg), their symptoms were resolved and continued with the moderate intensity statins. Furthermore, Statin was hold in 8 patients in the probable category for 4 weeks until the resolution of symptoms followed by moderate intensity statins.
Conclusion
Statin induced myalgia is more reported in old aged and female patients. Most of the patients can better tolerate the lower range of high intensity statins with the similar benefits and should be prescribed in every patient
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - U Yasin
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - T Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - J Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - S Khatti
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - K Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - N Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - M Naeem Mengal
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - N Qamar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Kumar D, Saghir T, Ali G, Yasin U, Furnaz S, Karim M, Hussain M, Kumari R, Bai R, Kumar H. Psychosocial Impact of COVID-19 on Healthcare Workers at a Tertiary Care Cardiac Center of Karachi Pakistan. J Occup Environ Med 2021; 63:e59-e62. [PMID: 33234873 PMCID: PMC7864597 DOI: 10.1097/jom.0000000000002094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Aim of this study was to determine the depression, stress, and anxiety level among healthcare workers working at a tertiary care cardiac center of Karachi Pakistan during COVID-19 pandemic. METHODS This survey was conducted at the National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Participants of the study were fulltime employees of hospital. Data were collected using an online questionnaire and Depression, Anxiety and Stress - 21 (DASS-21) scale was used. RESULTS A total of 224 healthcare workers were included, 46 (20.5%) participants were screened for moderate to severe depression, 20.1% (45) for moderate to severe anxiety, and 14.7% (33) for moderate to severe stress. CONCLUSION A significant levels of depression, anxiety, and stress were noted with the major concerns of workplace exposure, increased risk of infection, and transmission to their families and friends.
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Affiliation(s)
- Dileep Kumar
- National Institute of Cardiovascular Diseases (Dr Kumar, Dr Saghir, Dr Ali, Dr Yasin, Ms Furnaz, Mr Karim, Dr Hussain); Dow Medical College (Dr Bai), Karachi; Medical officer of Government of Sindh (Dr Kumari, Dr Kumar), Pakistan
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