Use of Statin and Target Low-density lipoprotein cholesterol attainment among post-ST elevation myocardial infarction patients in Shahid Gangalal National Heart Centre, Kathmandu, Nepal

BACKGROUND

and objective: Lipid-lowering is an important intervention to reduce cardiovascular morbidity and mortality in the secondary prevention of STEMI. There is no study to analyze the use of statin and LDL-C treatment target attainment among STEMI patients in Nepal. This study aims to assess the use of statin and LDL-C treatment target attainment among STEMI patients.

METHODS

It was a prospective observational single-center study conducted at the Shahid Gangalal National Heart Centre, Kathmandu, Nepal outpatient department. An outpatient department-based survey was conducted among STEMI patients who have lipid profile levels at the time of admission for STEMI and after 4-13 weeks of the index event. Lipid profile levels, diagnosis, and risk factors were collected during the outpatient follow-up.

RESULTS

Our study included 280 post-STEMI patients; the mean age was 57.5±11.7 years with the majority being male. The mean duration of follow-up was 6.7 ± 0.1 weeks. Rosuvastatin was the preferred statin with 82.1%. The most common dose of statin used was Rosuvastatin 20mg (70%), followed by Atorvastatin 40mg (12.5%). LDL-C levels of <1.4mmol/l were achieved in 44.6% of cases and LDL levels of <1.8mmol/l in 71.8% of cases. In 36.8% of the study population, there was a greater than 50% decline in LDL-C levels. Diabetic patients (55.1% and 83.1%) only have the significant achievement of LDL goal of both <1.4mmol/l and <1.8mmol/l respectively, when compared to those without diabetes (44.9% and 16.9%).

CONCLUSIONS

Most of the post-STEMI patients were treated with high doses of statins and achieved the target LDL-C levels.

Patterns of Perception of Cardiac Symptoms by Patients Presenting with ST-Segment Elevation Myocardial Infarction and their Knowledge of Coronay Artery Disease Risk Factors

BACKGROUND

Proper knowledge regarding Coronary Artery Disease and their risk factors is essential for the early recognition of the disease and its presentation. This study was conducted to identify pattern of clinical symptoms and knowledge regarding Coronary Artery Disease risk factors among ST-Elevation myocardial infarction (STEMI) patients.

METHODS

This cross-sectional, observational study was conducted among 340 ST-Elevation myocardial infarction patients in the inpatient Cardiology Department of Shahid Gangalal National Heart Centre Nepal, from November 2020 to February 2021. Baseline clinical characteristics, knowledge regarding Coronary Artery Disease risk factors, patterns of symptoms, and prehospital delay were collected and evaluated.

RESULTS

In our study, 299 (87.9%) had typical ischemic chest pain during the symptom onset, however, only 81 (23.8%) perceived chest pain as cardiac disease, and 311 (91.5%) of the patients presented to the nearby health care center within the recommended time of less than 12 hours for the reperfusion therapy of ST-Elevation myocardial infarction. Perception of symptoms as a cardiac origin and typical chest pain were not significantly associated with earlier presentation. Also, the typical chest pain was not significantly associated with the perception of the symptom as a cardiac origin. The history of Coronary Artery Disease was considered as a Coronary Artery Disease risk factor by 184(54.1%) of the study population and 137(40.3%), 132(38.8%), 110(32.4%), 105(30.9%) and 71(20.9%) considered hypertension, smoking, age, obesity, and diabetes mellitus as a Coronary Artery Disease risk factor respectively.

CONCLUSIONS

Though most patients presented with typical chest pain, identification of the chest pain as a cardiac origin and the awareness of the Coronary Artery Disease risk factors was low.

Safety and Efficacy of Single vs Dual Antiplatelets Therapy After Atrial Septal Defect Device Closure

BACKGROUND

Atrial septal defect device closure has become a standard procedure. Antiplatelet therapy is used to prevent thrombus formation in the device. There is no clear recommendation about the antiplatelets drugs. This study aims to evaluate the safety and efficacy of Aspirin vs (Aspirin +Clopidogrel) after device closure.

METHODS

A cross-sectional study was conducted among all consecutive adult patients (?18 years) who underwent atrial septal defect device closure from May 2019 to April 2020 and meet the inclusion criteria were included. After successful ASD device closure patients were treated with ASA or combination of ASA and Clopidogrel for six months on physician discretion. Patients were followed up for six months to observe for Transient ischemic attack, Stroke, thrombus in the device, myocardial infarction, major bleeding, minor bleeding and increases in headache episodes compared to baseline.

RESULTS

This study consisted of 130 patients: 65 in the Aspirin Group, and 65 patients in Aspirin and Clopidogrel group. There was no Transient ischemic attack, Stroke, Myocardial infarction, thrombus, major bleeding in both groups. There was no significant difference between two groups in ecchymosis; Aspirin group 4(6.1%) vs. aspirin and Clopidogrel group 3(4.6%) [Difference, 1.54% {95, % CI, -1.45%to 4.53%}]; P=0.648. There was no significant difference in increase in headache episodes compared to baseline for six months after the device closure in Aspirin Group 3(4.6%) VS Aspirin and Clopidogrel group 2 (3.0%) group [difference, 1.54% {95% CI, -1.45%to 4.53%}]; P=0.648.

CONCLUSIONS

Our study suggests that single antiplatelet therapy with Aspirin is as safe and effective as aspirin and clopidogrel after device closure.

OPTN/SRTR 2011 Annual Data Report: international data

For the first time, OPTN/SRTR has undertaken to publish global transplant rates as part of its Annual Data Report. Understanding why rates vary from country to country may lead to a better understanding of how to improve access to transplant everywhere. Availability of information varies substantially from country to country, and how complete and accurate the data are is difficult to ascertain. For Canada, Malaysia, and the United Kingdom, data were supplied at SRTR request from well-known registries. For many other countries, SRTR was unable to obtain information, and data from the World Health Organization's Global Observatory on Donation and Transplantation were used. Transplant counts and rates vary substantially around the world, likely due to 1) differences in rates of end-organ diseases, 2) economic differences in the ability to provide transplants or other end-organ disease treatment, 3) cultural differences that might support or hinder organ donation and transplant, and 4) reporting differences.

OPTN/SRTR 2011 Annual Data Report: pancreas

Numbers of pancreas transplants have been decreasing over the past decade, but outcomes continue to improve for all types: simultaneous pancreas-kidney transplant, pancreas after kidney transplant (PAK), and pancreas transplant alone (PTA). The most notable decrease occurred for PAK transplants, possibly due in part to decreases in numbers of living donor kidney transplants. The number of new candidates on the pancreas transplant waiting list has decreased steadily since 2000; only 1005 active candidates were added in 2011. Transplant rates for all pancreas transplant types reached a low in 2011 of 34.9 transplants per 100 wait-list years. Deceased donation rates have also been decreasing since 2005, but use of donation after circulatory death has been gradually increasing. The discard rate in 2011 was 27.7%, and higher for pancreata recovered from older donors. Improved outcomes during the early posttransplant period largely reflect improved donor and recipient selection and improved technical strategies. Inconsistent definitions of graft failure across reporting centers creates an ongoing challenge in the interpretation of outcome data for pancreas transplants. Rates of posttransplant re-hospitalization are high, most occurring in the first 6 months. Rejection rates are highest for PTA recipients, who also experience higher incidence of posttransplant lymphoproliferative disorder.

Lung and heart allocation in the United States

Lung and heart allocation in the United States has evolved over the past 20-30 years to better serve transplant candidates and improve organ utilization. The current lung allocation policy, based on the Lung Allocation Score, attempts to take into account risk of death on the waiting list and chance of survival posttransplant. This policy is flexible and can be adjusted to improve the predictive ability of the score. Similarly, in response to the changing clinical phenotype of heart transplant candidates, heart allocation policies have evolved to a multitiered algorithm that attempts to prioritize organs to the most infirm, a designation that fluctuates with trends in therapy. The Organ Procurement and Transplantation Network and its committees have been responsive, as demonstrated by recent modifications to pediatric heart allocation and mechanical circulatory support policies and by ongoing efforts to ensure that heart allocation policies are equitable and current. Here we examine the development of US lung and heart allocation policy, evaluate the application of the current policy on clinical practice and explore future directions for lung and heart allocation.