Critical Thinking

Materials was the sum-up of components.All the patients

Materials
and Methods

This
is a prospective, observational study conducted in Sri Venkateswara Institute
of Medical sciences, Tirupati, India. A total of 376 consecutive patients with
CAD, which includes ST elevation myocardial infarction (STEMI), non-ST
elevation myocardial infarction (NSTEMI), unstable angina (USA) and chronic
stable angina (CSA) were included in the study.  Patients with renal dysfunction, bleeding diathesis,
post CABG, post PTCA, atrial fibrillation and pregnant women were excluded from
the study.

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Detailed
medical history, physical examination, electrocardiography and echocardiogram
were performed. The following components of CHA2DS2-VASc
score were obtained for each patient: Heart failure (defined as signs/symptoms
of heart failure confirmed with objective evidence of cardiac dysfunction or
left ventricular ejection fraction126 mg/dL or blood glucose ? 200 mg/dL or using antidiabetic drugs),
previous ischaemic stroke or TIA, vascular disease (defined as MI and
peripheral artery disease including prior revascularisation, amputation or
angiographic evidence or aortic plaque) and gender. Each component will be
scored as per table 1, total score
was the sum-up of components.All
the patients underwent CAG, using Judkins technique (Philips or seimens)
transradial or  transfemoral approach.
CAG and SYNTAX scores were examined by two experienced interventional
cardiologists who were blinded to the clinical characteristics and laboratory
results of the patients. According to the baseline diagnostic angiogram, each coronary
lesion creating a stenosis obstructing ?50% of the diameter in vessels ?1.5 mm
was scored separately, and these scores were added together to produce the
overall SYNTAX score which calculated  using
the SYNTAX score algorithm, which is available on SYNTAX website.13 Low, intermediate and high SYNTAX score were defined as 0 to 22, 23
to 32 and 33 or more, respectively. Bilateral common
carotid arteries of the subjects was scanned longitudinally with an L 11-3 MHz
linear transducer attached  to an
available machine (PHILIPS IE 33). The bulb dilation served as a landmark to
indicate the border between the distal common carotid artery and the carotid
bulb. Images were obtained from the distal portion of the common carotid
artery, 1–2 cm proximal to the carotid bulb. The two bright echogenic lines in
the arterial wall were identified as the intima and media lines. The
intima-media thickness was measured as the distance from  the leading edge of the first to the leading
edge of the second echogenic line. Only arterial wall
intima-media thickness of the distal 1-cm portion of the common carotid artery,
just before bifurcation, was measured at end-diastole. Images showing the
maximum intima-media thickness were stored in a digitized fashion and CIMT
measurements were made off line.

The
study was conducted according to the recommendations of the Declaration of Helsinki
on Biomedical Research Involving Human Subjects. The Institutional Ethics
Committee approved the study protocol, and each participant provided written,
informed consent.

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