The Journal of Cardiovascular Diseases

Predictors of Procedural Success and Complications in Percutaneous Coronary Intervention for Chronic Total Occlusions

2026-01-26T07:26:07+00:00

Abstract

Objective: To identify the predictors of procedural success and complications in Percutaneous Coronary Intervention (PCI) for Chronic Total Occlusions (CTOs) in patients at Hayatabad Medical Complex, Peshawar, Pakistan.

Methodology: A retrospective cohort study was conducted with 150 patients who underwent PCI for CTO between June 2024 and June 2025. Demographic data, lesion characteristics, procedural details, and complications were analyzed. Statistical analysis included descriptive statistics, chi-square tests, independent t-tests, and multivariable logistic regression to identify predictors of procedural success.

Results: The study found that 78% of patients had procedural success, while 22% had failed procedures. Significant predictors of success included age (p = 0.04), J-CTO score (p = 0.002), and approach used (p = 0.01). Males had a significantly higher procedural success rate compared to females (p = 0.03). Logistic regression revealed that younger age (OR = 0.98, p = 0.03), lower J-CTO score (OR = 1.5, p = 0.01), and antegrade approach (OR = 2.0, p = 0.05) were independent predictors of success.

Conclusion: The study concludes that procedural success in CTO PCI is influenced by patient age, lesion complexity, and the approach used. These findings are important for guiding clinical decisions in CTO PCI, suggesting that younger patients with less complex lesions and an antegrade approach should be prioritized. Future studies with larger, multicenter cohorts are needed to validate these results.

Keywords: Chronic total occlusion, Percutaneous coronary intervention, J-CTO score, Procedural success, Logistic regression.

Frequency of Left Bundle Branch Block in Patients with Coronary Artery Disease at Hayatabad Medical Complex, Peshawar

2026-01-22T07:19:54+00:00

Abstract

Objective: To determine the frequency and clinical significance of left bundle branch block (LBBB) in patients with coronary artery disease (CAD) admitted to the Department of Cardiology, Hayatabad Medical Complex, Peshawar.

Methodology: A prospective cross-sectional study was conducted over six months, from 18th April 2025 to 18th October 2025, including 101 patients aged 40 to 75 years with angiographically confirmed CAD. Consecutive sampling was used to enroll participants. Clinical data were collected through structured proformas, and electrocardiographic evaluation was used to identify LBBB, defined as QRS duration >120 ms with characteristic morphology. Data were analyzed using SPSS version 26. Descriptive statistics summarized demographics, and chi-square and t-tests assessed associations, while logistic regression identified predictors of heart failure hospitalization.

Results: Of the 101 patients, 55 were males (54.5%) and 46 were females (45.5%), with a mean age of 58.4 ± 8.3 years. The prevalence of LBBB was 48.5% (n=49). Hypertension was found in 53.5% and diabetes in 48.5% of patients. Patients with LBBB were significantly older (p=0.015) and had higher BMI (p=0.029). Chi-square analysis showed a significant association between LBBB and hypertension (p=0.023). Logistic regression revealed LBBB (OR=2.12, p=0.027) and hypertension (OR=1.93, p=0.034) as independent predictors of heart failure hospitalization.

Conclusion: Nearly half of CAD patients exhibited LBBB, which was significantly associated with hypertension, older age, and increased risk of heart failure hospitalization. Early recognition of LBBB may improve patient management and prognosis. Larger multicenter studies are recommended to validate these findings.

Keywords: Left Bundle Branch Block; Coronary Artery Disease; Hypertension; Heart Failure; Electrocardiography

New onset diabetes in patients undergoing CABG: A single center registry analysis

2025-12-27T07:49:10+00:00

Abstract

Background: Diabetes mellitus is prevalent in 40–50% of patients undergoing coronary artery bypass grafting (CABG). While glycosylated hemoglobin (HbA1C) is common in this group, the incidence of new-onset diabetes after CABG remains uncertain.

Objectives: To determine the incidence of new-onset diabetes following CABG and its impact on intensive care unit (ICU) and hospital stay in a Pakistani cohort.

Methods: We analyzed retrospective data from hospital registry for consecutive adult patients undergoing CABG at a single tertiary care center from January 2025 to August 2025. Patients with known diabetes were excluded. Descriptive and comparative analyses were performed.

Results: Of 1,559 patients (1,355 men, 204 women), 933 without pre-existing diabetes were included in the analysis. During hospitalization, 57 patients (6.1%) developed persistently elevated glucose levels at discharge, yielding an incidence of 61 ± 5 per 1,000. Compared with those who remained non-diabetic, patients with new-onset diabetes had similar age and body mass index but a higher prevalence of preoperative impaired HbA1C (44.6% vs. 13.7%). They also had longer ICU stay (102.0 ± 75 vs. 80.2 ± 29 hours) and hospital stay (11.7 ± 5.7 vs. 9.6 ± 2.4 days) (p < 0.001).

Conclusion: New-onset diabetes is unmasked in a notable proportion of non-diabetic patients following CABG, particularly among those with preoperative impaired HbA1C levels. Its occurrence is associated with prolonged ICU and hospital stay, highlighting the need for closer perioperative glucose surveillance in this high-risk population.

Keywords: CABG surgery, Diabetes, Impaired HbA1C, Intensive care unit

Association between Frontal QRS-T Angle on electrocardiography and early mortality in patients with heart failure

2026-01-26T06:55:30+00:00

Background:

Local study regarding association between frontal QRS-T Angle on electrocardiography and mortality may help develop guidelines to reduce morbidity and mortality in heart failure.

Objective: To determine the association between Frontal QRS-T Angle on electrocardiography and mortality in patients with heart failure.

Material and Methods:

A Prospective Cohort Study was conducted from January 2021 to December 2022 in different cardiology departments of Punjab province. A total of 672 consecutive patients i.e. 336 with high QRS T Frontal angle (group A with angle > 900) and 336 with normal QRS T Frontal angle presenting with heart failure to outpatient and emergency department were matriculated for the study. All patients were followed for any adverse event i.e. mortality for three months by telephone on first of every month. Presence of diabetes & hypertension and history of smoking were treated as effect modifier.

Results: 672 patients were included in our sample with mean age of 57.86 ± 5.8 years. 466 patients (69.3%) were male while remaining 206 patients (30.7%) were female. 145 patients (21.6%) died within three months. 110 patients with raised QRS T frontal angle died within three months while only 35 patients with normal QRS T frontal angle died within three months. Diabetes, hypertension, smoking, male gender and age were significant contributor to mortality.

Conclusion:

It is concluded that there is association of raised QRS T frontal angle (> 900) with mortality in patients with heart failure. QRS T frontal angle can be used as cost effective sign of increased risk of mortality in patients with heart failure.

Kidney Dysfunction and the Risk of Slow-Flow / No-Reflow During Primary PCI for Acute Myocardial Infarction

2025-12-30T11:17:00+00:00

Background:

Primary percutaneous coronary intervention (pPCI) is considered the gold standard treatment for patients with acute ST-elevation myocardial infarction (STEMI), as it significantly lowers both short and long-term mortality. This procedure successfully restores normal blood flow (TIMI-3 flow) in the infarct-related artery (IRA). Compromised kidney function is a recognized predictor of increased mortality and complications in STEMI patients undergoing primary PCI (pPCI). This adverse prognostic effect can appear even with a mild reduction in renal function. Several studies have also identified impaired kidney function as an independent risk factor for the development of the slow-flow or no-reflow (SF/NR) phenomenon.

Objective: To see the association of kidney dysfunction with patients having slow-flow/no- reflow phenomenon in STEMI patients undergoing pPCI and to evaluate its prognostic effect on short-term mortality in our local population

Material and Methods: The prospective observational study was conducted from 20-01-2025 to 15-05-2025 at the Cardiology Department, PIC Lahore. Patients of both genders age ranging from 18-75 years were enrolled to investigate the association between estimated glomerular filtration rate (eGFR) or serum creatinine and the incidence of SF/NR who were undergoing pPCI.

Results: Total enrollment of 227 patients having mean age 56.1 years, 154(68.0%) males and 73(32.0%) females, in which 16(7.0%) developed slow-flow/no-reflow post-PCI. Duration of pain, A.Fib, complete heart block, and heart failure have statistically significant differences as p- value < 0.05 and poorer baseline renal function, as evidenced by a lower eGFR (76.5±5.4 vs. 89.6±1.0 mL/min/1.73m², p=0.001). Angiographically, the no-reflow group had higher rates of pre- procedural total occlusion (TIMI 0 flow) and lower stent implantation rates. Mortality 1(6.3%) observed in slow / no-flow group with an insignificant p-value 0.141. Increasing age is an independent predictor, with each additional year raising the odds of slow/no-flow by about 4%. Hypertension doubled the likelihood of developing no-reflow p-value 0.020.

Conclusion: Impaired renal function significantly predicts slow-flow/no-reflow following primary PCI, underscoring the need for renal-based risk stratification before intervention