1.Definite stent thrombosis among Malaysian population: predictors and insights of mechanisms from intracoronary imaging
Lim Kien Chien ; Yap Lok Bin ; Amin Ariff Nuruddin
The Medical Journal of Malaysia 2020;75(5):472-478
Introduction: Stent thrombosis (ST) is an uncommon, but
significant complication following angioplasty. We aimed to
examine the predictors, clinical outcomes and mechanism
of definite ST cases among patients who underwent
percutaneous coronary intervention (PCI).
Methods: This was a retrospective observational registry of
14,935 patients from the year 2011 till 2015. Clinical
characteristics, clinical outcome and intracoronary imaging
data were recorded in all the patients. The SPSS Statistic
version 24 was used for statistical analysis. The Cox
regression hazard model was used to report calculate the
hazard ratio (HR) with a 95% confidence interval (95%CI).
Independent predictors of ST were identified by univariate
logistic regression analysis. Variables that showed a
statistically significant effect in univariate analyses were
entered in a multivariate Cox proportional hazards model. A
p-value<0.05 was regarded as significant.
Results: The incidence of definite ST was 0.25% (37 out of
14935 patients). 75% of ST group patients presented with ST
elevation myocardial infarction (75% vs. 19.8%, p<0.01).
There was higher mortality among patients with ST when
compared to the group without ST (Hazard Ratio, HR=10.69,
95%CI: 1.13, 100). Two independent predictors of ST were 1)
previous history of acute myocardial infarction (HR=2.36,
95%CI: 1.19, 4.70) and 2) PCI in the context of acute coronary
syndrome when compared to elective PCI (HR=37, 95%CI:
15.7, 91.5). Examination of 19 ST cases with intracoronary
imaging identified nine cases (47%) of underexpanded
stents and five cases (26%) of malopposition of stents.
Conclusions: ST is associated with high mortality. PCI in
acute coronary syndrome setting and a previous history of
acute myocardial infarction were significant predictors for
ST. Intracoronary imaging identified stent underexpansion
and malopposition as common reasons for ST. In cases
where the risk of ST is high, the use of intracoronary
imaging guided PCI is recommended.
2.Diastolic dysfunction grading, echocardiographic and electrocardiogram findings in 50 patients with apical hypertrophic cardiomyopathy
Aslannif Roslan ; Suraya Hani Kamsani ; Hui Beng Koh ; Yee Sin Tey ; Kin Leong Tan ; Chan Ho Tham ; Mohd Saad Jalaluddin ; Mohamed Nazrul Mohamed Nazeeb ; Nay Thu Win ; Ahmad Tantawi Jauhari Aktifanus ; Malini Kerisnan ; Wan Nabeelah ; Muhd Najmi Hakim Abdul Rani ; Ai Ming Tan ; Amin Ariff Nuruddin
The Medical Journal of Malaysia 2019;74(6):521-526
Introduction: Apical Hypertrophic Cardiomyopathy (Apical
HCM) is an uncommon variant of hypertrophic
cardiomyopathy, but it is relatively more common in Asian
countries. This is a retrospective, non-randomised, single
centre study of patients with Apical HCM focusing on their
diastolic dysfunction grading, echocardiographic
parameters and electrocardiograms (ECG).
Methods: All Apical HCM patients coming for clinic visits at
the Institut Jantung Negara from September 2017 to
September 2018 were included. We assessed their
echocardiography images, grade their diastolic function and
reviewed their ECG on presentation.
Results: Fifty patient were included, 82% (n=41) were males
and 18% (n=9) females. The diastolic function grading of 37
(74%) patients were able to be determined using the updated
2016 American Society of Echocardiography (ASE) diastolic
guidelines. Fifty percent (n=25) had the typical ace-ofspades shape left ventricle (LV) appearance in diastole and
12% (n=6) had apical pouch. All patients had T inversion in
the anterior leads of their ECG, and only 52% (n=26) fulfilled
the ECG left ventricular hypertrophy (LVH) criteria. Majority
of our patients presented with symptoms of chest pain (52%,
n=26) and dyspnoea (42%, n=21).
Conclusion: The updated 2016 ASE guideline makes it easier
to evaluate LV diastolic function in most patients with Apical
HCM. It also helps in elucidating the aetiology of dyspnoea,
based on left atrial pressure. Clinicians should have a high
index of suspicion for Apical HCM when faced with deep T
inversion on ECG, in addition to a thick LV apex with an aceof-spades appearance during diastole.