Mohammad Naeem Malik, Asad Riaz, Sidra Zahoor.
Comparison between Angiographic Severity of Lesions in Patients with Acute Myocardial Infarction with and without Thrombolytic Therapy.
Ann Pak Inst Med Sci Jan ;13(1):17-22.

Objective: To compare angiographic severity of stenosis using Gensini and CASS score in patients undergoing angiography after receiving thrombolytic therapy for acute STEMI versus those who didn’t receive thrombolytic therapy. Methodology: All patients with and without symptoms of ischemia showing new ischemic changes on ECG, new onset pathological Q waves or regional wall motion abnormalities associated with significantly elevated cardiac markers (as defined above) were included in this study after being screened according to inclusion and exclusion criteria. All the patients were then evaluated for the suitability of thrombolytic therapy (time from symptom onset and absence of contraindications). The patients were subsequently divided into 2 subsets, those receiving thrombolytic therapy and those who did not receive thrombolytic therapy on account of either contraindications to thrombolysis or delayed presentation (>12 hours). Both these subsets were then subjected to coronary angiography with intent of performing PCI after obtaining informed consent and the angiographic stenosis severity was compared using the Gensini and CASS scores. Results: A total of 108 patients were included (54 in each group). The mean age was 49.57 ±12.3 years, mean hemoglobin was 13.67± 2.05 g/dL and mean serum creatinine level was 1.79±0.8 mg/dL. Anterior MI was the most frequent MI location (41.7%). Maximum no. of patients had a single vessel coronary artery disease (49.1%). The mean gensini score was 14.81±10 in thrombolyzed group while it was 7.53±4 in the non thrombolyzed group (P value 0.00). The mean CASS score was 1.51±0.8 in the thrombolyzed group and 1.88±0.79 in the non thrombolyzed group (P value 0.013). Conclusion: Thrombolytic therapy for acute MI alters significantly, the angiographic lesion severity, and hence may reduce the incidence of ischemic complications and favourably affect prognosis in patients treated at a non-primary PCI capable facility. Objective: To find out the patient satisfaction level after day case surgery under local anaesthesia at PIMS, Islamabad.

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