Ussama Munir - Academia.edu (original) (raw)

Papers by Ussama Munir

Bangladesh Heart Journal, 2019

Background: Although transradial approach (TRA) has better outcome and reduced vascular complicat... more Background: Although transradial approach (TRA) has better outcome and reduced vascular complications, radial artery occlusion (RAO) is now a major concern as it limits future radial artery use for further TRA, for use as a conduit during CABG, for invasive hemodynamic monitoring and for creation of arteriovenous fistula for hemodialysis in CKD patients. Vascular doppler study is the most accurate method for evaluation of RAO and yet this is not practiced in our population. Objectives: To detect the frequency and identify the predictors of RAO after coronary procedure through TRA. Methods: This cross-sectional analytical study was done in the department of cardiology, NICVD from July-2015 to June- 2016 by including a total 125 patients undergoing coronary procedures (CAG and/or PCI) through TRA. Vascular doppler study of the radial artery were performed before and one day after the procedure. RAO was defined as an absence of antegrade flow and monophasic flow on doppler study. Univa...

American Heart Journal, 2009

Background-TIMI Risk Index (TRI) is a simple bedside score that predicts 30-day mortality in ST-e... more Background-TIMI Risk Index (TRI) is a simple bedside score that predicts 30-day mortality in ST-elevation myocardial infarction (MI) patients. We sought to evaluate whether TRI was predictive of long-term mortality and clinical events. Methods-In the TIMI II trial, 3153 patients (mean age 57 ±10 years, 82% men) were randomized to invasive (n=1583) versus conservative (n=1570) strategy post-fibrinolysis with median follow-up of 3 years. TRI was divided into the 5 previously-specified groups. Primary endpoint was all-cause mortality. Secondary analyses included recurrent MI, congestive heart failure (CHF), and combined endpoints. Results-When compared to Group 1, mortality in Group 5 was more than 5-fold higher (HR 5.83, p<0.0001), and was also increased in Group 4 (HR 2.80, p<0.0001) and Group 3 (HR 1.96, p=0.002) (c statistic 0.69). No difference was seen between Groups 1 and 2 (p=0.74). A similar increasing gradient effect was seen across TRI strata with Group 5 having the highest risk for CHF (HR 4.13, p<0.0001), and composite death/CHF (HR 4.35, p<0.0001) over Group 1. There was no difference in recurrent MI between the groups (p=0.22). After controlling for other risk indicators, the relationship between TRI and mortality remained significant: Group 5 (HR 4.11, p<0.0001), Group 4 (HR 2.14, p=0.0009), Group 3 (HR 1.69, p=0.02). When stratified by TRI groups, no differences in mortality or composite death/MI were found between treatment strategies. Conclusion-The simple TRI can predict increased long-term mortality, CHF, and composite death/CHF.

Bangladesh Heart Journal, 2019

Background: Although transradial approach (TRA) has better outcome and reduced vascular complicat... more Background: Although transradial approach (TRA) has better outcome and reduced vascular complications, radial artery occlusion (RAO) is now a major concern as it limits future radial artery use for further TRA, for use as a conduit during CABG, for invasive hemodynamic monitoring and for creation of arteriovenous fistula for hemodialysis in CKD patients. Vascular doppler study is the most accurate method for evaluation of RAO and yet this is not practiced in our population. Objectives: To detect the frequency and identify the predictors of RAO after coronary procedure through TRA. Methods: This cross-sectional analytical study was done in the department of cardiology, NICVD from July-2015 to June- 2016 by including a total 125 patients undergoing coronary procedures (CAG and/or PCI) through TRA. Vascular doppler study of the radial artery were performed before and one day after the procedure. RAO was defined as an absence of antegrade flow and monophasic flow on doppler study. Univa...

American Heart Journal, 2009

Background-TIMI Risk Index (TRI) is a simple bedside score that predicts 30-day mortality in ST-e... more Background-TIMI Risk Index (TRI) is a simple bedside score that predicts 30-day mortality in ST-elevation myocardial infarction (MI) patients. We sought to evaluate whether TRI was predictive of long-term mortality and clinical events. Methods-In the TIMI II trial, 3153 patients (mean age 57 ±10 years, 82% men) were randomized to invasive (n=1583) versus conservative (n=1570) strategy post-fibrinolysis with median follow-up of 3 years. TRI was divided into the 5 previously-specified groups. Primary endpoint was all-cause mortality. Secondary analyses included recurrent MI, congestive heart failure (CHF), and combined endpoints. Results-When compared to Group 1, mortality in Group 5 was more than 5-fold higher (HR 5.83, p<0.0001), and was also increased in Group 4 (HR 2.80, p<0.0001) and Group 3 (HR 1.96, p=0.002) (c statistic 0.69). No difference was seen between Groups 1 and 2 (p=0.74). A similar increasing gradient effect was seen across TRI strata with Group 5 having the highest risk for CHF (HR 4.13, p<0.0001), and composite death/CHF (HR 4.35, p<0.0001) over Group 1. There was no difference in recurrent MI between the groups (p=0.22). After controlling for other risk indicators, the relationship between TRI and mortality remained significant: Group 5 (HR 4.11, p<0.0001), Group 4 (HR 2.14, p=0.0009), Group 3 (HR 1.69, p=0.02). When stratified by TRI groups, no differences in mortality or composite death/MI were found between treatment strategies. Conclusion-The simple TRI can predict increased long-term mortality, CHF, and composite death/CHF.