Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
Home Print this page Email this page
Users Online:824


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 3  |  Page : 65-69

Clinical characteristics, angiographic profile and in hospital mortality in acute coronary syndrome patients in south indian population


1 Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
2 Department of Cardiac Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India

Date of Web Publication5-Sep-2014

Correspondence Address:
Rajni Sharma
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jaya Nagar, 9th Block, Bannergahtta Road, Bengaluru - 560 069, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-449x.140228

Rights and Permissions
  Abstract 

Aims: The aim was to study the clinical profile, risk factors prevalence, angiographic distribution, and severity of coronary artery stenosis in acute coronary syndrome (ACS) patients of South Indian population. Materials and Methods: A total of 1562 patients of ACS were analyzed for various risk factors, angiographic pattern and severity of coronary heart disease, complications and in hospital mortality at Sri Jayadeva Institute of Cardiovascular Research and Sciences, Bengaluru, Karnataka, India. Results: Mean age of presentation was 54.71 ± 19.90 years. Majority were male 1242 (79.5%) and rest were females. Most patients had ST elevation myocardial infarction (STEMI) 995 (63.7%) followed by unstable angina (UA) 390 (25%) and non-STEMI (NSTEMI) 177 (11.3%). Risk factors; smoking was present in 770 (49.3%), hypertension in 628 (40.2%), diabetes in 578 (37%), and obesity in (29.64%) patients. Angiography was done in 1443 (92.38%) patients. left anterior descending was most commonly involved, left main (LM) coronary artery was least common with near similar frequency of right coronary artery and left circumflex involvement among all three groups of ACS patients. Single-vessel disease was present in 168 (45.28%) UA, 94 (56.29%) NSTEMI and 468 (51.71%) STEMI patients. Double-vessel disease was present in 67 (18.08%) UA, 25 (14.97%) NSTEMI and 172 (19.01%) STEMI patients. Triple vessel disease was present in 28 (7.55%) UA, 16 (9.58%) NSTEMI, 72 (7.95%) STEMI patients. LM disease was present in 12 (3.23%) UA, 2 (1.19%) NSTEMI and 9 (0.99%) STEMI patients. Complications; ventricular septal rupture occurred in 3 (0.2%), free wall rupture in 2 (0.1%), cardiogenic shock in 45 (2.9%), severe mitral regurgitation in 3 (0.2%), complete heart block in 11 (0.7%) patients. Total 124 (7.9%) patients died in hospital after 2.1 ± 1.85 days of admission. Conclusion: STEMI was most common presentation. ACS occurred a decade earlier in comparison to Western population. Smoking was most prevalent risk factor. Diabetic patients had more of multivessel disease. Complications and in hospital mortality was higher in females and elderly population.

Keywords: Acute coronary syndrome, coronary angiogram, non-ST elevation myocardial infarction, ST elevation myocardial infarction, unstable angina


How to cite this article:
Sharma R, Bhairappa S, Prasad S R, Manjunath CN. Clinical characteristics, angiographic profile and in hospital mortality in acute coronary syndrome patients in south indian population . Heart India 2014;2:65-9

How to cite this URL:
Sharma R, Bhairappa S, Prasad S R, Manjunath CN. Clinical characteristics, angiographic profile and in hospital mortality in acute coronary syndrome patients in south indian population . Heart India [serial online] 2014 [cited 2019 Dec 10];2:65-9. Available from: http://www.heartindia.net/text.asp?2014/2/3/65/140228


  Introduction Top


Coronary artery disease (CAD) is leading cause of mortality worldwide [1] and by the year 2020, will be first in the leading causes of disability. [2] While the death rates have been declining for the past three decades in the west, these rates are rising in India. In the last three decades, the prevalence of CAD has increased from 1.1% to about 7.5% in the urban population and from 2.1% to 3.7% in the rural population. [3] CAD tends to occur at a younger age in Indians, with more extensive angiographic involvement [4] contributed genetic, metabolic, conventional and nonconventional risk factors. [5],[6] The objective of this study was to represents the clinical profile, prevalence of risk factors and distribution of coronary artery stenosis in acute coronary syndrome (ACS) patients of South Indian population.


  Materials and methods Top


One thousand five hundred and sixty-two consecutive patients presented to Sri Jayadeva Institute of Cardiovascular Research and Sciences, Bengaluru, Karnataka, India with first episode of ACS were analyzed. The clinical presentations of patient were categorized as unstable angina (UA), non-ST elevated myocardial infarction (NSTEMI) and STEMI according to American College of Cardiology/American Heart Association (ACC/AHA) definitions and treated as per ACC/AHA recommendations. [7],[8] Patients with concomitant valvular heart disease or cardiomyopathy were excluded from this study.

The following data were included for analysis: Age and gender and CAD risk factor profile, comprised of current cigarette/bidi smoking history, dyslipidemia was defined as the presence of any of the following: Patients on lipid lowering drugs or total cholesterol >240 mg/dl, triglycerides (TG) >150 mg/dl, low-density lipoprotein >130 mg/dl, and high-density lipoproteins (HDL) <50 mg/dl for female and <40 mg/dl for male. Diabetes mellitus symptoms of diabetes and plasma glucose concentration ≥200 mg/dl (11.1 mmol/L), or fasting blood sugar ≥126 mg/dl (7.0 mmol/L) or 2-hp ≥200 mg/dl (11.1 mmol/L), hypertension (systolic blood pressure ≥140 and/or diastolic ≥90 mmHg and/or on anti-hypertensive treatment), family history of CAD (first degree relatives before the age of 55 years in men and 65 years in women), obesity was defined using the body mass index (BMI) with a value >30. BMI was calculated using Quetlet's formula (weight in kg/height in m 2 ). Clinical manifestations, left ventricular ejection fraction, hematologic indices, coronary angiographic findings, and treatment strategy were reported. Selective coronary angiogram was done using standard technique within 48 h of admission unless patient is hemodynamically unstable or with deranged renal parameters. Expert opinion on coronary angiography was taken by two cardiologist. Significant CAD was defined as a diameter stenosis >50% in each major epicardial artery. Normal vessels were defined as the complete absence of any disease in the left main coronary artery (LMCA), left anterior descending (LAD), right coronary artery (RCA), and left circumflex (LCX) as well as in their main branches (diagonal, obtuse marginal, ramus intermedius, posterior descending artery, and posterolateral branch). Patients were classified as having single-vessel disease (SVD), double-vessel disease (DVD) or triple vessel disease (TVD) accordingly.

Statistical analysis

The results were reported as mean ± standard deviation for the quantitative variables and percentages for the categorical variables. The groups were compared using the Student's t-test for the continuous variables and the Chi-square test for the dichotomous variables. P < 0.05 were considered as statistically significant. All the statistical analyses were carried out via Statistical Package for Social Sciences version 20 (SPSS, IL, Chicago Inc., USA).


  Results Top


Among 1562 ACS patients majority were male 1242 (79.5%) and 320 (20.5%) were female. The mean age of presentation for male was 53.28 ± 11.54 and for female was 60.23 ± 17.67 (P = 0.001). Most common presentation in ACS was STEMI with 995 (63.7%) patients followed by UA 390 (25%) and NSTEMI 177 (11.3%). Baseline characteristics are mentioned in [Table 1].
Table 1: Baseline characteristics

Click here to view


Risk factor analysis

A total of 578/1562 (37%) patients were diabetic and 628/1562 (40.2%) patients were hypertensive. Smoking was most prevalent risk factor seen in 770/1562 (49.30%) patients. Active smoking in our study was noticed only in male, that is, 770 (62%) of total male (1242) patients. Women were rather tobacco chewers. Dyslipidemia was present in 593/1562 (37.96%) patients. Obesity in 463/1562 (29.64%) patients and family history of CAD was significant in 152/1562 (9.73%) patients.

Angiographic profile

Most common coronary artery to be involved was LAD followed by near similar frequencies of RCA and LCX involvement with least common involvement of LMCA in all three groups (UA, NSTEMI and STEMI). [Table 2] among UA patients SVD was seen in 168 (45.28%) patients, DVD in 67 (18.06%) patients, TVD in 28 (7.55%) patients, LM disease in 12 (3.23%) patients and normal vessels or nonsignificant lesion seen in 96 (25.88%) patients out of 371 patients. In NSTEMI SVD was present in 94 (56.29%), DVD in 25 (14.97%), TVD in 16 (9.58%), LM in 2 (1.19%) and normal vessel or nonsignificant lesion seen in 30 (17.97%) out of 167 patients. In STEMI, SVD was seen in 468 (51.71%), DVD in 172 (19.01%), TVD in 72 (7.95%), LM in 9 (0.99%) and normal vessel or nonsignificant lesions seen in 184 (20.34%) out of 905 patients [Table 3].
Table 2: In ACS patients various pattern of coronary artery involvement

Click here to view
Table 3: Distribution of coronary vessels involvement in ACS patients

Click here to view


Single-vessel disease was present in 127 (46.02%) of female patients whereas 603 (51.67%) of male patients (P < 0.001). DVD was present in 44 (15.94%) female patients in comparison to 220 (18.85%) male patients. TVD was seen in 27 (9.78%) female patients but in 89 (7.62%) male patients. LMCA disease was seen in 3 (1.09%) female patients whereas in 20 (1.71%) male patients (P > 0.05). Normal or mild disease was present in 75 (27.17%) of female patients compared with 235 (20.15%) of male patients (P < 0.01). Diabetic patients had trend toward multivessel disease in comparison to nondiabetic patients. DVD was seen in 113 (21.08%) of diabetic patients, whereas in 151 (16.65%) of nondiabetic patients. TVD was present in 52 (9.70%) diabetic patients, but in 64 (7.06%) nondiabetic patients. LMCA disease was present in 9 (1.68%) diabetic patients in comparison to 14 (1.54%) nondiabetic patients (P > 0.05).

Complication of acute coronary syndrome

Three (0.2%) patients had ventricular septal rupture (VSR) and all three were female. Two (0.1%) patients had free wall rupture, one male and one female. Severe mitral regurgitation was seen in 3 (0.2%) patients, two were female and one patient was male. Cardiogenic shock was seen in total 45 (2.9%) patients, 11/320 (3.44%) were female and 34/1242 (2.73%) were male. Eleven (0.7%) patients had complete heart block, 3 (0.2%) were female and 8 (0.5%) were male. Ventricular tachycardia occurred in 8 (0.5%) patients, three were female and five were male patients. Pulmonary edema occurred in total 37 (2.4%) patients, 14 (4.37%)/320 were female and 23/1242 (1.85%) were male patients.

Mortality data

Among 1562 ACS patients 124 (7.9%) patients died in hospital after 2.18 ± 1.85 days of admission. Mortality was more in elderly population with mean age of 61.14 ± 12.33 years in comparison to patients discharged from hospital having mean age of 54.14 ± 20.32 years (P < 0.001). Mortality was more in female patients 44/320 (13.75%), whereas in men mortality occurred in 80/1242 (6.44%) patients with P < 0.01. The mean age of mortality in female was higher 62.18 ± 11.9 years in comparison to male 60.70 ± 12.56 years (P > 0.05). In hospital mortality occurred in 43/578 (7.44%) diabetic patients whereas in 81/984 (8.23%) nondiabetic patients (P > 0.05). In diabetics mean age of mortality was 61.19 ± 11.80 years in comparison to 61.30 ± 13.4 years in nondiabetics (P > 0.05).


  Discussion Top


Epidemiological studies have revealed that the prevalence of CAD is increasing along with the rising prevalence of conventional risk factors for CAD in India. Present health transition from predominance of infections to the preponderance of cardiovascular disorders, such as hypertension, diabetes, and CAD is now responsible for 53% of all deaths. [6],[ 6],[9] Indians have one of the highest rates of heart disease in the world. The disease also tends to be more aggressive and manifests at a younger age. [10] However, in our study, the mean age of presentation was 54.70 ± 19.90 years comparable to other studies done in India, that is, CREATE registry (56 ± 13 years) and Jose and Gupta study (57 ± 12 years) but lower than the western population as in COURAGE trial 62 ± 5 years conducted in USA, study by Hochman et al.[11] (69 years), and Chang et al. (73 years). [12] The skewed gender distribution males 79.5% versus females 20.5% of the study population can be attributed to the gender bias and atypical presentation, which is also a feature in INTERHEART study and its South Asian cohort (overall male, 76% and South Asian cohort, 85%). [13] MI without previous angina pectoris is more common in younger patients with CAD [14],[15] as seen in our study, the mean age of STEMI patients was 53.38 ± 11.53 years compared with UA patients (57.85 ± 14.34 years). Studies on histopathology has shown that those plaques would have been more lipid containing with relative lack of acellular scar tissue and present for a shorter period of time or developed more quickly than plaques seen in older patients. These plaques are more unstable and likely to rupture, attributing for having more of STEMI at younger age than chronic stable angina. [16] The most common presentation among ACS patients is STEMI in comparison to UA or NSTEMI. Our study showed that the prevalence of diabetics was 37%, which is higher than the reported prevalence in other nations (INTERHEART study) but near to other Indian studies (CREATE, Jose and Gupta). [6],[16],[17] Indians natives now constitute the largest population of diabetics in the world. The number of diabetics in India is projected to surpass 57.2 million by 2025. [5] The relatively high prevalence of DVD (21.08%) and TVD (9.70%) in diabetic patients when compared with nondiabetics (16.65%) and (7.06%) respectively along with a similar mean age confirms the role of diabetes as a chronic risk factor in CAD. Others have also reported diabetes to be a predictor of presence of multivessel disease. [16] Hypertension is another conventional risk factor implicated in CAD. In our study 40.2% patients were hypertensive. The prevalence of hypertension in South Asian cohort of INTERHEART study (31.1%) is comparatively lower than in our study but near to other Indian studies. [6],[17] The higher prevalence of diabetes and hypertension in this region could be explained by the comparatively higher development and increasing epidemic of CAD. [18]

Tobacco smoking is a known modifiable risk factor for CAD. In our study, 49.3% patients were smoker. Patients who were smoking had more commonly STEMI compared with UA/NSTEMI. In our study, 560/770 (72.73%) of smoker patients had STEMI comparable to other studies. [19] The prevalence of obese patients was 29.64% which is less than the prevalence seen in South Asian cohort of INTERHEART study (44.2%). May be obesity prevalence has turned out low in study because of using BMI as marker of obesity instead of waist: Hip ratio used in INTERHEART study population. Lakka et al. in their study have reported that abdominal obesity is an independent risk factor for ACS in middle-aged men and combination with smoking, the risk of coronary events increases by 5.5 times. [19] Obesity has become an epidemic and rapidly growing public health hazard. Central obesity (visceral fat) corresponding to increased waist circumference is an important component of the insulin resistance-hyperinsulinemia syndrome, and has been found to be more frequent in persons of Indian origin. Whereas no significant correlation could be found between the levels of lipid parameters and the severity of CAD on angiography. Others have also reported similar findings in their study except that they reported a relationship between the C/HDL-cholesterol (HDL-C) ratio and the severity of CAD. [19] Hughes et al. showed an increased relative risk of MI directly with TG and inversely with HDL-C levels in Asian Indians. [20]

Single-vessel involvement was most prevalent in all groups of ACS including UA/NSTEMI and STEMI, followed by double-vessel and triple vessel similar to Kumar et al. study and Tewari et al. [16],[21] SVD was also most commonly involved in male as well as female patients followed by DVD, and TVD with statistical significance, similar to Kumar et al. and Tewari et al. study from north India. Left main disease did not show statistical significant difference in view of diabetes or gender distribution. UA was more commonly associated with normal coronaries (15.6%) compared to NSTEMI (11.4%) and STEMI (9.72%). In UA group many patients may have been over diagnosed, false positive as ACS especially in females. Angiographically the absolutely normal vessels were present in 9.42% cases of STEMI have been attributed to complete recanalization whether spontaneous or postthrombolysis. [22]

Complications occurred more commonly in female patients and elderly population as VSR, cardiogenic shock, free wall rupture and pulmonary edema as explained by other studies as well. [23],[24] In hospital mortality was also significantly higher in female patients. Diabetes did not influence the short term outcome and in hospital mortality in our studies. Recently, studies has shown that yet diabetes prevalence is on increase but all complications in diabetic patients is toward downhill course, maximum fall is seen in acute MI and mortality. [25]

The study limitations include the noninclusion of factors like detailed dietary habits, exercise frequency and alcohol consumption, as the primary aim was to study the clinical correlation with angiographic profile of the first event of ACS patients. The waist hip ratio, which is better marker for measurement of obesity, was not used in our study. In mortality group, only five patients could undergo angiogram because of unstable condition, which restricted us in commenting on how CAD severity influenced the mortality group.


  Conclusion Top


Acute coronary syndrome occurs 5-10 years earlier in Indian population compared to western population. Higher prevalence of diabetes and hypertension in Indian subcontinent. Overall SVD was most prevalent in ACS patients. Diabetic patients had more of multivessel disease than nondiabetics. Complications such as VSR, free wall rupture, heart failure and cardiogenic shock were more commonly seen in elderly female patients. Mortality is more in female patients with higher mean age than in male patients. In hospital mortality was more in first 2-3 days of ACS presentation. Diabetes did not impact on short term outcome or mortality of ACS patients.

 
  References Top

1.American Heart Association / American Stroke Asssociation statistical data on highlights of acute coronary syndrome, 2005.  Back to cited text no. 1
    
2.Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997;349:1269-76.  Back to cited text no. 2
    
3.Chadha SL, Radhakrishnan S, Ramachandran K, Kaul U, Gopinath N. Epidemiological study of coronary heart disease in urban population of Delhi. Indian J Med Res 1990;92:424-30.  Back to cited text no. 3
    
4.Enas EA, Yusuf S, Mehta JL. Prevalence of coronary artery disease in Asian Indians. Am J Cardiol 1992;70:945-9.  Back to cited text no. 4
    
5.Deedwania P, Singh V. Coronary artery disease in South Asians: evolving strategies for treatment and prevention. Indian Heart J 2005;57:617-31.  Back to cited text no. 5
    
6.Gupta R, Gupta VP. Meta-analysis of coronary heart disease prevalence in India. Indian Heart J 1996;48:241-5.  Back to cited text no. 6
    
7.AHA/ACC Guidelines for Management of STEMI; 2014.  Back to cited text no. 7
    
8.AHA/ACC Guidelines for Management of UA/NSTEMI; 2011.  Back to cited text no. 8
    
9.Gupta R, Deedwania PC, Gupta A, Rastogi S, Panwar RB, Kothari K. Prevalence of metabolic syndrome in an Indian urban population. Int J Cardiol 2004;97:257-61.  Back to cited text no. 9
    
10.Enas EA, Yusuf S, Mehta J. Meeting of the International Working Group on Coronary Artery Disease in South Asians. 24 March 1996, Orlando, Florida, USA. Indian Heart J 1996;48:727-32.  Back to cited text no. 10
    
11.Hochman JS, Tamis JE, Thompson TD, Weaver WD, White HD, Van de Werf F, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb Investigators. N Engl J Med 1999;341:226-32.  Back to cited text no. 11
    
12.Chang WC, Kaul P, Westerhout CM, Graham MM, Fu Y, Chowdhury T, et al. Impact of sex on long-term mortality from acute myocardial infarction vs unstable angina. Arch Intern Med 2003;163:2476-84.  Back to cited text no. 12
    
13.Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet 2004;364:937-52.  Back to cited text no. 13
    
14.Glover MU, Kuber MT, Warren SE, Vieweg WV. Myocardial infarction before age 36: Risk factor and arteriographic analysis. Am J Cardiol 1982;49:1600-3.  Back to cited text no. 14
    
15.Nitter-Hauge S, Erikssen J, Thaulow E, Vatne K. Angiographic and risk factor characteristics of subjects with early onset ischaemic heart disease. Br Heart J 1981;46:325-30.  Back to cited text no. 15
    
16.Tewari S, Kumar S, Kapoor A, Singh U, Agarwal A, Bharti BB, et al. Premature coronary artery disease in North India: An angiography study of 1971 patients. Indian Heart J 2005;57:311-8.  Back to cited text no. 16
    
17.Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): A prospective analysis of registry data. Lancet 2008;371:1435-42.  Back to cited text no. 17
    
18.Farmer JA, Gotto AM. Dyslipidemia and other risk factors for coronary heart disease. In: Braunwald E, editor. Heart Disease: A Textbook of Cardiovascular Medicine. 5 th ed. Philadelphia: WB Saunders; 1997. p. 1126-60.  Back to cited text no. 18
    
19.Lakka HM, Lakka TA, Tuomilehto J, Salonen JT. Abdominal obesity is associated with increased risk of acute coronary events in men. Eur Heart J 2002;23:706-13.  Back to cited text no. 19
    
20.Hughes LO, Wojciechowski AP, Raftery EB. Relationship between plasma cholesterol and coronary artery disease in Asians. Atherosclerosis 1990;83:15-20.  Back to cited text no. 20
    
21.Kumar N, Sharma S, Mohan B, Beri A, Aslam N, Sood N, et al. Clinical and angiographic profile of patients presenting with first acute myocardial infarction in a tertiary care center in Northern India. Indian Heart J 2008;60:210-4.  Back to cited text no. 21
    
22.Mohammad AM, Sheikho SK, Tayib JM. Relation of cardiovascular risk factors with coronary angiographic findings in Iraqi patients with ischemic heart disease. Am J Cardiovasc Dis Res 2013;1:25-9.  Back to cited text no. 22
    
23.Ghadimi H, Bishehsari F, Allameh F, Bozorgi AH, Sodagari N, Karami N, et al. Clinical characteristics, hospital morbidity and mortality, and up to 1-year follow-up events of acute myocardial infarction patients: The first report from Iran. Coron Artery Dis 2006;17:585-91.  Back to cited text no. 23
    
24.Chatterjee K. Complications of acute myocardial infarction. Curr Probl Cardiol 1993;18:1-79.  Back to cited text no. 24
    
25.Edward W. Gregg, Ph.D., Yanfeng Li, M.D., Jing Wang, M.D., Nilka Rios Burrows, M.P.H., Mohammed K. Ali, M.B., Ch.B., Deborah Rolka, M.S., Desmond E. Williams, M.D., Ph.D., and Linda Geiss, M.A. N Engl J Med 2014; 370:1514-1523April 17, 2014DOI: 10.1056/NEJMoa1310799, 25.Changes in Diabetes-Related Complications in the United States, 1990-2010  Back to cited text no. 25
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


This article has been cited by
1 Three dimensional echocardiography in non ST elevation acute coronary syndrome in North India (3D-EINSTEIN) - A single centre prospective study
Dibbendhu Khanra,SK Sinha,Pradyot Tiwari,MM Razi,Puneet Aggrawal,Shishir Soni,CM Verma,Ramesh Thakur,Bhanu Duggal
Journal of the Practice of Cardiovascular Sciences. 2019; 5(2): 94
[Pubmed] | [DOI]
2 Prevalence and characteristics of dual left anterior descending artery in adult patients undergoing coronary angiography
Navdeep Singh Sidhu,Gagandeep Singh Wander
Future Cardiology. 2019;
[Pubmed] | [DOI]
3 Epidemiology and risk factors of patients with types of acute coronary syndrome presenting to a tertiary care hospital in Sri Lanka
Udaya Ralapanawa,Pallegoda Vithanage Ranjith Kumarasiri,Kushalee Poornima Jayawickreme,Prabashini Kumarihamy,Yapa Wijeratne,Madhushanka Ekanayake,Chandira Dissanayake
BMC Cardiovascular Disorders. 2019; 19(1)
[Pubmed] | [DOI]
4 An interesting case of vasospastic angina associated with systemic smooth muscle disorder
Chanakya Kishore Kammaripalli
IHJ Cardiovascular Case Reports (CVCR). 2018;
[Pubmed] | [DOI]
5 Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India
Santanu Guha,Rishi Sethi,Saumitra Ray,Vinay K. Bahl,S. Shanmugasundaram,Prafula Kerkar,Sivasubramanian Ramakrishnan,Rakesh Yadav,Gaurav Chaudhary,Aditya Kapoor,Ajay Mahajan,Ajay Kumar Sinha,Ajit Mullasari,Akshyaya Pradhan,Amal Kumar Banerjee,B.P. Singh,J. Balachander,Brian Pinto,C.N. Manjunath,Chandrashekhar Makhale,Debabrata Roy,Dhiman Kahali,Geevar Zachariah,G.S. Wander,H.C. Kalita,H.K. Chopra,A. Jabir,JagMohan Tharakan,Justin Paul,K. Venogopal,K.B. Baksi,Kajal Ganguly,Kewal C. Goswami,M. Somasundaram,M.K. Chhetri,M.S. Hiremath,M.S. Ravi,Mrinal Kanti Das,N.N. Khanna,P.B. Jayagopal,P.K. Asokan,P.K. Deb,P.P. Mohanan,Praveen Chandra,(Col.) R. Girish,O. Rabindra Nath,Rakesh Gupta,C. Raghu,Sameer Dani,Sandeep Bansal,Sanjay Tyagi,Satyanarayan Routray,Satyendra Tewari,Sarat Chandra,Shishu Shankar Mishra,Sibananda Datta,S.S. Chaterjee,Soumitra Kumar,Soura Mookerjee,Suma M. Victor,Sundeep Mishra,Thomas Alexander,Umesh Chandra Samal,Vijay Trehan
Indian Heart Journal. 2017; 69: S63
[Pubmed] | [DOI]
6 Comparison of the Diameters of the Major Epicardial Coronary Arteries by Angiogram in Asian-Indians Versus European Americans <40 Years of Age Undergoing Percutaneous Coronary Artery Intervention
Amgad N. Makaryus,Rajiv Jauhar,Leanne M. Tortez,Renee Pekmezaris
The American Journal of Cardiology. 2017;
[Pubmed] | [DOI]
7 Clinico-angiographic profile and procedural outcomes in patients undergoing percutaneous coronary interventions: The Srinagar registry
Jahangir Rashid Beig,Tariq R. Shah,Imran Hafeez,Mohd Iqbal Dar,Hilal A. Rather,Nisar A. Tramboo,Ajaz A. Lone,Fayaz A. Rather
Indian Heart Journal. 2017;
[Pubmed] | [DOI]
8 Clinico-Angiographic Profile and Prevalence of Restenosis in Patients Undergoing Percutaneous Transluminal Coronary Angioplasty to Left Main Coronary Artery: An Observational Cohort Study
Dolly Mathew,C. G. Sajeev
World Journal of Cardiovascular Diseases. 2017; 07(11): 413
[Pubmed] | [DOI]
9 Management Protocols of stable coronary artery disease in India: Executive summary
Sundeep Mishra,Saumitra Ray,Jamshed J. Dalal,J.P.S. Sawhney,S. Ramakrishnan,Tiny Nair,S.S. Iyengar,Vinay K. Bahl
Indian Heart Journal. 2016; 68(6): 868
[Pubmed] | [DOI]
10 Management standards for stable coronary artery disease in India
Sundeep Mishra,Saumitra Ray,Jamshed J. Dalal,J.P.S. Sawhney,S. Ramakrishnan,Tiny Nair,S.S. Iyengar,V.K. Bahl
Indian Heart Journal. 2016; 68: S31
[Pubmed] | [DOI]
11 Time to shift from contemporary to high-sensitivity cardiac troponin in diagnosis of acute coronary syndromes
Jamshed J. Dalal,C.K. Ponde,Brian Pinto,C.N. Srinivas,Joy Thomas,Sunil Kumar Modi,Sanjay Mehta,Suvin Shetty,Suvin Manimarane,Bhupen Desai
Indian Heart Journal. 2016;
[Pubmed] | [DOI]
12 CLINICAL AND ANGIOGRAPHIC PROFILE OF FEMALES IN CENTRAL INDIA PRESENTING WITH ACUTE CORONARY SYNDROME
Tribhuwan Nath Dubey,Abhinav Kumar
Journal of Evolution of Medical and Dental Sciences. 2016; 5(61): 4258
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Materials and me...
Results
Discussion
Conclusion
Introduction
References
Article Tables

 Article Access Statistics
    Viewed5998    
    Printed168    
    Emailed1    
    PDF Downloaded1011    
    Comments [Add]    
    Cited by others 12    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]