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The Rate of Discordance between Syntax Score II and Cardiologist Decision as a Guide for Mode of Revascularization in Patients with Complex Coronary Artery Disease
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treatment decisions for percutaneous coronary intervention (PCI) and/or coronary artery bypass graft (CABG) in patients with complex coronary artery disease (CAD) and/or unprotected left main stem disease (ULMSD).
Objectives: To assess the agreement between the clinical decisions of the cardiologist and the SS II recommendation regarding the revascularization strategies in patients with complex CAD and/or ULMSD.
Patients and Methods: Prospective data from patients who presented to Baghdad Medical City Catheterization Labs for coronary angiography and were followed up between January 2014 and November 2015 were analyzed. For these patients, SS II was assessed by the two anatomical variables (SS and presence of ULMSD) and six clinical variables (age, creatinine clearance, left ventricular ejection fraction, sex, chronic obstructive pulmonary disease, and peripheral vascular disease) to predict 4-year mortality after revascularization with PCI and/or CABG. These scores were then compared with the clinical decisions of cardiologists. After 1 year of data collection, we followed up the patients by phone to assess their mortality status. Patients were categorized into three groups according the interventional procedures: Group 1 (for PCI), Group 2 (for CABG), and Group 3 (for PCI vs. CABG).
Results: Two hundred patients were enrolled. Their mean age was 60.23 ± 9.836 years, and 157 (78.5%) were men. Depending on the clinical judgment of the cardiologist, 71 (35.5%) patients were referred for PCI (Group 1), 119 (59.5%) patients for CABG (Group 2), and the remaining 10 (5%) patients for PCI vs. CABG (Group 3). Based on an assessment of 4-year mortality by the SS II, CABG would have been the treatment of choice in 67 (33.5%) patients, PCI in 30 (15%) patients, and both the treatments in 103 (51.5%) patients. There was a concordance between the clinical decision of the cardiologist and SS II in 67 (33.5%) patients and discordance in 133 (66.5%) patients. Six patients died within 1 year, most of whom were from the discordant group.
Conclusion: There was a statistically significant discordance between the SS II recommendation and clinical judgment of the interventional cardiologist. SS II proved to be a useful objective tool to assist experienced clinical judgment in determining appropriate revascularization strategy for CAD patients.

المقدمة:درجة السنتاكس ٢ تعد طريقة ارشادية لاختيار طريقة العلاج في المرضى اللذين يعانون من امراض شرايين القلب التاجية المعقدة مع او بدون امراض الشريان الايسر الرئيسي غير المحمي.

الهدف: لتقييم نسبة عدم التوافق بين القرار السريري لاختصاصي القلبية وتوصيات درجة السنتاكس ٢ بالنسبة لخطة العلاج في المرضى المصابين بآمراض شرايين القلب التاجية المعقدة مع او بدون امراض الشريان الايسر الرئيسي غير المحمي.                       

طرائق البحث: يتم جمع معلومات المرضى اللذين يخضعون لاجراء القسطرة التشخيصية لشرايين القلب في صالات القسطرة في مدينة الطب وتتم متابعة المرضى ايضا وتكون مدة الدراسة للفترة من شهر كانون الثاني لسنة ٢٠١٤م الى شهر تشرين الثاني لسنة ٢٠١٥م وخلال هذه الفترة يتم تقييم المرضى عن طريق درجة السنتاكس ٢ وست متغيرات سريرية للتنبؤ بآحتمالية حدوث الوفاة خلال الاربع سنوات بعد عودة التوعي ومقارنتها مع القرار السريري لاختصاصي القلبية. ثم بعد مرور سنة على جمع الداتا، نقوم بمتابعة حالة المرضى عن طريق الاتصال الهاتفي لمعرفة إذا حدثت حالات الوفاة. يتم تقسيم المرضى الى ٣ مجاميع، المجموعة الاولى والتي تخضع للتداخل القسطاري، المجموعة الثانية والتي تخضع لعملية جراحية لزرع شرايين القلب، والمجموعة الثالثة والتي لديها احتمالية للخضوع للقسطرة او للعملية الجراحية.    

النتائج: تم اشراك مئتا مريض في الدراسة، معدل العمر ٦٠.٢٣ ± ٩.٨٣٦سنة، ١٥٧ (٧٨.٥٪) من المرضى ذكور. بالاعتماد على القرار السريري لاختصاصي القلبية تم تحديد ٧١ (٣٥.٥٪) من المرضى للخضوع للتداخل القسطاري (المجموعة الاولى)، ١١٩ (٥٩.٥٪) من المرضى تم ارسالهم لاجراء عملية جراحية (المجموعة الثانية) وبقية المرضى ١٠ (٥٪) تم ادراجهم تحت احتمالية خضوعهم للتداخل القسطاري او العملية الجراحية. بالنسبة لتققيم حالة الوفاة للاربع سنوات بالاعتماد على درجة السنتاكس ٢، كانت النتيجة ان العلاج المفضل هو العمليات الجراحية وبنسبة ٣٣.٥٪، في حين ان نسبة المرضى الخاضعين للتداخل القسطاري كانت ١٥٪، وكانت النسبة متوازية بالنسبة للمرضى الخاضعين للعمليات الجراحية او التداخل القسطاري ٥١.٥٪. كان هنالك توافق بين القرار السريري لاختصاصي القلبية ودرجة السنتاكس ٢ وبنسبة ٣٣.٥٪، في حين ان نسبة عدم التوافق للمرضى كانت ٦٦.٥٪. خلال سنة واحدة توفي ستة مرضى ومعضمهم كانوا من مجموعة عدم التوافق.                 

الاستنتاج: هذه الدراسة اظهرت عدم توافق هام بين توصيات درجة السنتاكس ٢ والقرار السريري لاختصاصي القلبية.

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Publication Date
Thu Oct 01 2009
Journal Name
Journal Of The Faculty Of Medicine Baghdad
The Ankle- Brachial Pressure Index AS A Predictor of Coronary Artery Disease Severity
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Background: Atherosclerosis is a diffuse disease process, being present in one vascular bed predicts its presence in the others. Ankle –brachial pressure index (ABI) is a non invasive test proved to be sensitive and specific in detecting and assessing the severity of peripheral arterial disease.
Patients and Methods: One hundred fifty patients (150) were enrolled in this study, from January - June 2007; all were referred to the Iraqi Centre for Heart Diseases (I.C.H.D.) for further evaluation, with request for further assessment of CAD or lower extremity peripheral arterial disease. Clinical data and physical examination were performed; ABI was calculated by measurement of systolic pressure on both ankl

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Publication Date
Thu Feb 01 2018
Journal Name
European Journal Of General Medicine
The Value of Longitudinal Strain versus Coronary Angiography in Detection of Coronary Artery Disease
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Thu Dec 29 2022
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Correlation between coronary artery calcium score and aorta diameter in population with long-standing hypertension using noncontrast CT scan
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Chronic Kidny Disease and Risk of coronary Artery Disease,Aprospective study
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Sun Apr 01 2007
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Clinical And Angiographic Characteristics Of Left Main Coronary Artery Disease, A Retrospective Study
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Background : Left main coronary artery (LMCA) disease represents important and serious portion of coronary artery disease(CAD).
Aim: The aim of this study is to estimate the incidence of LMCA disease among patients with CAD undergoing coronary artery angiography and to evaluate clinical characteristics of patients with LMCA disease.
Methods: The study involved review of clinical notes and coronary angiography of 1020 patients with CAD in Ibin Al Bitar hospital for cardiac surgery between April and September 2004.This review included evaluation of electrocardiogram (ECG), echocardiogram(ECHO), ECG exercise test (EET) and coronary angiography.
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Publication Date
Wed Jan 05 2022
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Early complications associated with obesity following coronary artery bypass graft surgery: Obesity and post-CABG morbidity
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Background: One of the major health concerns and possible risk factors in open heart surgery is the increasing prevalence of obesity among patients.

Methodology: Over a period of sixteen months (February 2017 to June 2018), 246 patients underwent coronary artery bypass graft surgery (CABG) in Slemani Cardiac Hospital (SCH). The patients were divided according to the WHO classification into two groups: The obese (BMI ≥ 30) and the non-obese  (BMI < 30) and were compared in regard to the rate of occurrence of early postoperative complications.

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Importance of two-dimensional strain imaging in diagnosis of coronary artery disease
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Serum Level of Interleukin-33, C-Reactive Protein, and Troponin in Iraqi Coronary Artery Disease Patients
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     Coronary artery disease (CAD) is a condition of an inadequate supply of oxygenated blood to a portion of the myocardium. It typically occurs when there is an imbalance between supply and demand of myocardial oxygen. The most common cause of myocardial ischemia is atherosclerotic disease of an epicardial coronary artery or arteries which is sufficient to cause a regional reduction in myocardial blood flow and inadequate perfusion of the myocardium supplied by the involved coronary artery. Fifty CAD subjects (23 females and 27 males) were enrolled in this study in addition to thirty healthy control subjects (13 female and 17 male). This study aimed to measure the serum levels of interleukin IL- 33, C- reactive prot

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Gender Distribution of Coronary Artery Calcium Score and Degree of Stenosis Assessed by Computed Tomography Angiography in Iraqi Patients with Chest Pain
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Complete and Incomplete Revascularization of patients with Non-ST-Elevation Acute Coronary Syndrome using Angioplasty and Stenting.
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Background: Angioplasty and stenting; Percutaneous coronary intervention (PCI) has become important tool of Reascularizing patients with stable angina and Acute ST-Elevation Myocardial Infarction, while their role in Non ST-elevation Acute coronary syndrome is expanding.

Objestives: The aim was to study the outcome of complete and incomplete Revascularization, by PCI, of pts with NSTE-ACS, and the effect of the traditional risk factors and their relation to the number of stents.

Patients and Methods:- After stabilization 115 out of 142 consecutive hospital admissions with Non St-Elevation Acute Coronary Syndrome were revascularized Percutanously. 

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