Background- PTCA has been perfomed for more than 25 years as a treatment for coronary artery disease and now exceeds the annual volume of CABG. The first reported PTCA of a total occlusion was in 1982. Procedural success and restenosis rates have gradually improved since then. Methods-We studied 150 patients who underwent PTCA for recanalization of total occluded coronary artery from 2000 to 2003. The mean age of the subjects was 25-67 years. The locations of total occlusions were 50% in LAD, 38% in RCA and 12% in LCX. 65% of the patients had single vessel disease.Results:The success rate Was 65%, and stenting was done for 85% of the patients.Conclusion- It is now recognized that opening the chronic total occlusions of coronary arteries has proven benefits for patients,including an improvement in global and regional LV function, exercise capacity and reduced need for late CABG (by 50%). Angioplasty of total occlusions seems to be a safe and effective procedure in selected patients

Context: coronary artery disease is highly prevalent among patients with end stage renal disease/hemodialysis (ESRD/HD) and coronary Percutaneous interventions (PCI) has been increased by nearly 50% over the past decade. After PCI with stent placement, guidelines recommend dual antiplatelet therapy (DAPT), but no specifically tailored pharmacotherapy approach is outlined for this frail population, mostly excluded from large randomized clinical trials (RCTs).Evidence Acquisition: We reviewed current evidences on the use of antiplatelet therapy in patients with ESRD/HD undergoing PCI, focusing on the efficacy and safety of specific agents and their indications for detailed clinical settings.Results: Clinical setting in HD patients is the principal determinant of the type, onset, combination and duration of the DAPT. However, irrespective clinical setting, in addition to aspirin, clopidogrel is currently the most used antiplatelet agent even if no information derived from RCTs are available in ESRD. Due to the large experience acquired in routine clinical practice, the awareness of safety is higher for clopidogrel than newer antiplatelet agents. Because of lack of data, the use of prasugrel and ticagrelor is actually not recommended. However, in case of high ischemic and acceptable bleeding risk, they may be selectively used in ESRD/HD.Conclusions: This investigation might contribute to delineate the best treatment options for this high risk population.

Background and Aim: coronary Artery Diseases (CADs) affect different physical, social, and economic aspects of patients’,lives. The cost-effectiveness analysis is a way to examine both the costs and health outcomes of one or more therapeutic interventions of this disease. In other words, it compares an intervention to another one by estimating how much it costs to gain a unit of a health outcome, for instance, a life-year gained or death prevented. This study aimed to compare coronary Artery Bypass Graft (CABG) with Percutaneous coronary Intervention (PCI) in patients with CADs. Materials and Methods: This study is descriptive-analytical. It was conducted on 601 patients who underwent CABG (n=287) and PCI (n=314) in three aspects. The first aspect is to measure the effectiveness of CABG and PCI (cardiac mortality rate and quality of life). The second aspect is to estimate the direct costs (e. g. medical and non-medical costs) and indirect costs (e. g. productivity losses due to morbidity and mortality) based on a societal perspective. The third aspect is the cost-effectiveness analysis. The obtained data were analyzed with Markov cohort simulation using Excel and the TreeAge tool. Uncertainties related to model parameters were evaluated using 1-way and 2-way sensitivity analyses. Results: During the follow-up period, 2% and 0. 8% of patients died after CABG and PCI intervention, respectively. The Mean±, SD EuroQol-5 Dimension (EQ-5D) score after 12 months was 0. 72±, 0. 15 for the CABG group and 0. 66±, 0. 19 for the PCI group. All the therapeutic strategies yielded significant improvement in all dimensions during the follow-up. The mean annual total cost for the overall sample was $6243 per patient. This cost was significantly higher among patients who underwent CABG ($7234 per patient) than PCI ($5252 per patient). Direct costs accounted for 90%, and indirect costs accounted for 10% of the total costs. And the cost-effectiveness threshold was $14375. The Incremental CostEffectiveness Rate (ICER) in reducing mortality rate and increasing Quality of Life (QoL) was $-942. 7 and $106050, respectively. Conclusion: The present study found which intervention (PCI and CABG) had better cost-effectiveness in CAD patients. PCI intervention is more cost-effective than CABG in reducing mortality rate and increasing quality of life. This study tries to resolve the previous controversies regarding the most appropriate treatment for patients with coronary artery disease. It can have significant policy and clinical implications for health policymakers, cardiologists, and health managers.

Background: Retrospective studies and clinical trials have indicated that b-receptor blockers have an influential role in improving survival and reducing risk of recurrent infarction in patients with myocardial infarction. However, there is still controversy regarding the effects of b-receptor blockers on the markers of myocardial infarction following Percutaneous coronary interventions (PCI).Objective: The aim of this study was to evaluate the pre-treatment effect of Carvedilol on markers of myocardial injury in patients undergoing elective PCI.Method and Materials: In this clinical trial patients undergoing elective PCI were categorized randomly in the Carvedilol group including 100 patients who received two doses of 12.5 mg, 6 and 12 hours prior to PCI, and the control group (105 patients). Blood samples were obtained to analyse cardiac biomarker, 12 and 24 hours after PCI.Results: The clinical features were not significantly different between the two groups. A increase in the level of Troponin I was observed in the control group 24 hours following PCI (P=0.042), whereas this rise in troponin I was slight and insignificant in the Carvedilol group (P>0.05). some difference was observed between the two groups in regard to the level of CPK-MB after PCI (P=0.041).Conclusion: The findings of our study indicate that pre-treatment with Carvedilol confers cardio-protection by limiting the rise of markers of myocardial injury following PCI.

Background: Left ventricular dysfunction is considered a high-risk condition for performing either Percutaneous or surgical revascularization. The aim of this study was to evaluate immediate procedural and clinical outcomes and in-hospital complications of Percutaneous coronary interventions (PCI) in patients with coronary artery disease (CAD) and ventricular systolic dysfunction.Methods: Four hundred consecutive patients with documented obstructive CAD and left ventricular systolic dysfunction (EF <45%) were selected. Left ventricular ejection fraction was assessed via transthoracic echocardiography at the time of hospitalization. Indications for PCI were made on the basis of clinical and non-invasive studies. The majority of the patients (75%) were males, and their mean age was 55.9±10.7 years. More than half of the patients (56.78%) had multi-vessel disease. Multi-vessel PCI was performed in 51 (12.85%) patients. A total of 397 stents were implanted (0.99 stent/patient).Results: Technical procedural success was obtained in 96.75% of the patients. Procedural death was not seen. Non-Q wave acute myocardial infarction occurred in 12 (3%) patients, Q-wave AMI in four (1%), emergency coronary artery bypass grafting in six (1.5%), and cardiogenic shock in three (0.75%). Stroke did not occur in any cases. Major bleeding occurred in one (0.25%) patient, and 4.2% of the patients experienced minor bleeding.Conclusions: In patients with CAD and left ventricular systolic dysfunction, PCI can be performed with a good procedural outcome and acceptable in-hospital complications.

Objective: The resolution of ST-segment elevation (>50%) indicates successful reperfusion with thrombolytic therapy. The aim of this study is to evaluate the relation of ST-segment resolution post-primary Percutaneous cardiac intervention (PCI) with in-hospital mortality and coronary thrombolysis in myocardial infarction (TIMI) blood flow. Methods: This study is a single-centred retrospective study. The study enrolled 100 patients who were referred to the Nasiriya Heart Centre for primary PCI. We measured the ST segment amplitude in the lead with the highest elevation prior to primary PCI and assessed the ST-segment elevation post-primary PCI. The ratio of ST-segment resolution was calculated and considered complete if reaches ≥70% from the initial ST-segment elevation. We assessed the association of ST-segment resolution with in-hospital mortality. Results: Analysis of the electrocardiogram (ECG) showed that 21 patients (21%) had complete ST-segment (≥ 70%) resolution. No significant association was shown between ST-segment resolution and in-hospital mortality. Two out of 21 patients with complete ST-segment resolution died in the hospital and 6 out of 79 patients with incomplete ST-segment resolution died (P=0. 77). There is no significant association between ST-segment resolution and coronary TIMI flow grades. In patients with complete ST-segment resolution, 19 patients had TIMI III flow and 2 patients had TIMI II flow. In patients with incomplete ST-segment resolution, 72 patients had TIMI III flow, 6 patients had TIMI II flow,and 1 patient had no-reflow (P=0. 84). Conclusion: Complete ST-segment resolution in post-primary PCI settings has no significant association with in-hospital mortality. Absent or incomplete ST-segment resolution is not necessarily an indicator of coronary artery re-occlusion after primary PCI.