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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">JPSIM</journal-id>
      <journal-title-group>
        <journal-title>Journal of Pakistan Society of Internal Medicine</journal-title>
        <abbrev-title>J Pak Soc Intern Med</abbrev-title>
      </journal-title-group>
      <issn publication-format="print">2709-8729</issn>
      <issn publication-format="electronic">2710-0804</issn>
      <publisher>
        <publisher-name>Pakistan Society of Internal Medicine</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">10.70302/jpsim.v6i3.2551</article-id>
      <article-id pub-id-type="publisher-id">jpsim.v6i3.2551</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Original Research</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Evaluating Clinical Outcomes and Complications of Left Heart Catheterization as a Therapeutic Procedure in Acute Coronary Syndrome</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author" corresp="yes">
          <name>
            <surname>Daood</surname>
            <given-names>Muhammad Salman</given-names>
          </name>
          <email>muhammadsalmandaood43701@import.invalid</email>
          <xref ref-type="aff" rid="aff1"/>
          <xref ref-type="corresp" rid="cor1">*</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Butt</surname>
            <given-names>Muhammad Ahmad Raza</given-names>
          </name>
          <xref ref-type="aff" rid="aff2"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Anwar</surname>
            <given-names>Sidra</given-names>
          </name>
          <xref ref-type="aff" rid="aff3"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Rauf</surname>
            <given-names>Muhammad Kamran</given-names>
          </name>
          <xref ref-type="aff" rid="aff3"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Ghani</surname>
            <given-names>Mansoor</given-names>
          </name>
          <xref ref-type="aff" rid="aff4"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Mushtaq</surname>
            <given-names>Saliha</given-names>
          </name>
          <xref ref-type="aff" rid="aff5"/>
        </contrib>
      </contrib-group>
      <aff id="aff1">
        <institution>Alhada Military Hospital, Kingdom of Saudi Arabia</institution>
      </aff>
      <aff id="aff2">
        <institution>Hameed Latif Hospital, Lahore, Pakistan</institution>
      </aff>
      <aff id="aff3">
        <institution>Fatima Memorial Hospital, Lahore, Pakistan</institution>
      </aff>
      <aff id="aff4">
        <institution>University of Health Sciences, Lahore, Pakistan</institution>
      </aff>
      <aff id="aff5">
        <institution>Rehmatul-Lil- Alameen Institute of Cardiology PESSI Lahore, Pakistan</institution>
      </aff>
      <author-notes>
        <corresp id="cor1">*Correspondence: Muhammad Salman Daood (muhammadsalmandaood43701@import.invalid)</corresp>
      </author-notes>
      <pub-date date-type="pub" publication-format="electronic" iso-8601-date="2025-08-23">
        <day>23</day>
        <month>08</month>
        <year>2025</year>
      </pub-date>
      <pub-date date-type="collection" publication-format="electronic">
        <year>2025</year>
      </pub-date>
      <volume>6</volume>
      <issue>3</issue>
      <fpage>273</fpage>
      <lpage>278</lpage>
      <history>
        <date date-type="received" iso-8601-date="2024-09-06">
          <day>06</day>
          <month>09</month>
          <year>2024</year>
        </date>
        <date date-type="rev-recd" iso-8601-date="2025-01-10">
          <day>10</day>
          <month>01</month>
          <year>2025</year>
        </date>
        <date date-type="accepted" iso-8601-date="2025-07-24">
          <day>24</day>
          <month>07</month>
          <year>2025</year>
        </date>
      </history>
      <permissions>
        <copyright-statement>Copyright © 2025 The Author(s)</copyright-statement>
        <copyright-year>2025</copyright-year>
        <copyright-holder>The Author(s)</copyright-holder>
        <ali:free_to_read xmlns:ali="http://www.niso.org/schemas/ali/1.0/"/>
        <license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/">
          <ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/">https://creativecommons.org/licenses/by/4.0/</ali:license_ref>
          <license-p>This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
        </license>
      </permissions>
      <self-uri xlink:href="https://psimj.com/article/jpsim.v6i3.2551" content-type="text/html"/>
      <self-uri xlink:href="https://psimj.com/article/jpsim.v6i3.2551.pdf" content-type="application/pdf"/>
      <abstract>
        <sec>
          <title>Objective</title>
          <p>This study aimed to assess the prevalence and types of complications related to cardiac catheterization in patients with acute coronary syndrome (ACS), identify the most common adverse events such as bleeding, infections, pulmonary edema, contrast-induced nephropathy, arrhythmias, and stroke, and provide recommendations for their prevention, early detection, and management.</p>
        </sec>
        <sec>
          <title>Methodology</title>
          <p>A prospective study was conducted at Hameed Latif Hospital, Lahore, involving 220 patients diagnosed with ACS who underwent cardiac catheterization. Participants aged 18–75 years were selected through simple random sampling. Patients with prior CABG, bleeding disorders, advanced renal disease, pregnancy, or psychiatric illness were excluded. Data were collected on common post-catheterization complications, including vascular bleeding, infections, arrhythmias, contrast-induced nephropathy, stroke, and death. Ethical approval was obtained from the Institutional Review Board, and informed consent was secured from all participants. Data were analyzed using SPSS version 26, with results expressed as means, standard deviations, frequencies, and percentages, applying a significance level of 0.05.</p>
        </sec>
        <sec>
          <title>Results</title>
          <p>The patients had a mean age of 59.42 ± 9.36 years, with a slight male predominance (55.3%). Key complications identified included access site bleeding (0.9%), hematoma formation (2.6%), pulmonary edema (0.9%), cardiac arrhythmias (0.9%), cerebrovascular accidents (0.4%), acute stent thrombosis (0.4%), and death (0.4%). Radial access was used in 82.9% of procedures. No cases of contrast-induced nephropathy were reported.</p>
        </sec>
        <sec>
          <title>Conclusion</title>
          <p>The detailed focus on coronary angiography provided valuable insights into specific outcomes and significant complications. This research underscores the importance of specialized techniques and risk management in cardiac catheterization to better overall patient outcomes.</p>
        </sec>
      </abstract>
      <kwd-group xml:lang="en" kwd-group-type="author-keywords">
        <title>Keywords</title>
        <kwd>Cardiac catheterization</kwd>
        <kwd>Acute coronary syndrome</kwd>
        <kwd>Therapeutic</kwd>
        <kwd>Complications</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <!-- <body> omitted: no manuscript (.docx) on file -->
  <back>
    <notes notes-type="ethics-statement">
      <title>Ethics Statement</title>
      <p>Ethics committee: Institutional Review Board / Ethics Committee (IRB/EC). Approval number: HLH/IRB/2023-003, dated September 11, 2023.</p>
    </notes>
    <ref-list>
      <title>References</title>
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        <label>2</label>
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        <label>3</label>
        <mixed-citation>Marin AC, Prasad A, Machchhar RR, Patel V, Shah V, Ghodasara K, et al. A Case Report of Sepsis Post Cardiac Catheterization . Cureus. 2022 Dec 26; 14(12):e32977. <pub-id pub-id-type="doi">10.7759/cureus.32977</pub-id>. PMID: 36712763; PMCID: PMC9879584.</mixed-citation>
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        <mixed-citation>Chiarito, M, Cao, D, Nicolas, J, Roumeliotis A, Power D, Chandiramani R, et al. Radial versus femoral access for coronary interventions: An updated systematic review and meta-analysis of randomized trials. Catheter CardiovascInterv. 2021; 97: 1387-96.</mixed-citation>
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        <mixed-citation>Noto TJ Jr, Johnson LW, Krone R, Weaver WF, Clark DA, Kramer JR Jr et al. Cardiac catheterization 1990: a report of the registry of the Society for Cardiac Angiography and Interventions (SCA&amp;I). Cathet Cardiovasc Diagn. 1991;24(2):75–83.</mixed-citation>
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      </ref>
      <ref id="ref13">
        <label>13</label>
        <mixed-citation>Kolte D, Spence N, Puthawala M, Hyder O, Tuohy CP, Davidson CB, et al. Association of radial versus femoral access with contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Cardiovasc Revasc Med. 2015;17(8): 546-51.</mixed-citation>
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      <ref id="ref14">
        <label>14</label>
        <mixed-citation>Ram P, Horn B, Lo KBU, Pressman G, Rangaswami J. Acute Kidney Injury Post Cardiac Catheterization: Does Vascular Access Route Matter? Curr Cardiol Rev. 2019;15(2):96-101.</mixed-citation>
      </ref>
      <ref id="ref15">
        <label>15</label>
        <mixed-citation>Alkagiet S, Petroglou D, Nikas DN, Kolettis TM. Access-site Complications of the Transradial Approach: Rare But Still There. Curr Cardiol Rev. 2021;17(3):279-93.</mixed-citation>
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        <mixed-citation>Ullrich H, Münzel T, Gori T. Coronary Stent Thrombosis- Predictors and Prevention. Dtsch Arztebl Int. 2020;117(18):320-26.</mixed-citation>
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        <label>17</label>
        <mixed-citation>Martín-Aguilar L, Paré-Curell M, Dorado L, Pérez de la Ossa-Herrero N, Ramos-Pachón A, López-Cancio E, et al. Ischaemic stroke as a complication of cardiac catheterisation. Clinical and radiological characteristics, progression, and therapeutic implications. Neurologia (Engl Ed). 2022;37(3):184-91.</mixed-citation>
      </ref>
      <ref id="ref18">
        <label>18</label>
        <mixed-citation>Shaik FA, Slotwiner DJ, Gustafson GM, Dai X. Intra-procedural arrhythmia during cardiac catheterization: A systematic review of literature. World J Cardiol. 2020; 12(6):269-84.</mixed-citation>
      </ref>
      <ref id="ref19">
        <label>19</label>
        <mixed-citation>Doyle BJ, Rihal CS, Gastineau DA, Holmes DR Jr. Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention: implications for contemporary practice. J Am Coll Cardiol. 2009;53(22):2019-27.</mixed-citation>
      </ref>
      <ref id="ref20">
        <label>20</label>
        <mixed-citation>Marin AC, Prasad A, Machchhar RR, Patel V, Shah V, Ghodasara K, et al. A Case Report of Sepsis Post Cardiac Catheterization . Cureus. 2022 Dec 26; 14(12):e32977. <pub-id pub-id-type="doi">10.7759/cureus.32977</pub-id>. PMID: 36712763; PMCID: PMC9879584.</mixed-citation>
      </ref>
      <ref id="ref21">
        <label>21</label>
        <mixed-citation>Sudarsky D, Nikolsky E. Contrast-induced nephropathy in interventional cardiology. Int J NephrolRenovasc Dis. 2011;4:85-99.</mixed-citation>
      </ref>
      <ref id="ref22">
        <label>22</label>
        <mixed-citation>Cortese B, Sciahbasi A, Sebik R, Rigattieri S, Alonzo A, Silva-Orrego P, et al. Comparison of risk of acute kidney injury after primary percutaneous coronary interventions with the transradial approach versus the transfemoral approach (from the PRIPITENA urban registry). Am J Cardiol. 2014;114(6):820-5.</mixed-citation>
      </ref>
      <ref id="ref23">
        <label>23</label>
        <mixed-citation>Dukkipati S, O'Neill WW, Harjai KJ, Sanders WP, Deo D, Boura JA, etal. Characteristics of cerebrovascular accidents after percutaneous coronary interventions, J Am Coll Cardiol.2004;43(7):1161-7.</mixed-citation>
      </ref>
      <ref id="ref24">
        <label>24</label>
        <mixed-citation>Chiarito, M, Cao, D, Nicolas, J, Roumeliotis A, Power D, Chandiramani R, et al. Radial versus femoral access for coronary interventions: An updated systematic review and meta-analysis of randomized trials. Catheter CardiovascInterv. 2021; 97: 1387-96.</mixed-citation>
      </ref>
      <ref id="ref25">
        <label>25</label>
        <mixed-citation>Cram P, House JA, Messenger JC, Piana RN, Horwitz PA, Spertus JA. Percutaneous coronary intervention outcomes in US hospitals with varying structural characteristics: analysis of the NCDR®. Am Heart J. 2012;163(2):222-9.e1.</mixed-citation>
      </ref>
      <ref id="ref26">
        <label>26</label>
        <mixed-citation>Mohammed A. Al-Hijji, Ryan J. Lennon, Rajiv Gulati, Abdallah El Sabbagh, et al. Safety and Risk of Major Complications With Diagnostic Cardiac Catheterization. Cardiov Interv. 2019;12:e007791)</mixed-citation>
      </ref>
      <ref id="ref27">
        <label>27</label>
        <mixed-citation>Noto TJ Jr, Johnson LW, Krone R, Weaver WF, Clark DA, Kramer JR Jr et al. Cardiac catheterization 1990: a report of the registry of the Society for Cardiac Angiography and Interventions (SCA&amp;I). Cathet Cardiovasc Diagn. 1991;24(2):75–83.</mixed-citation>
      </ref>
      <ref id="ref28">
        <label>28</label>
        <mixed-citation>Johnson LW, Lozner EC, Johnson S, Krone R, Pichard AD, Vetrovec GW, et al. Coronary arteriography 1984-1987: a report of the Registry of the Society for Cardiac Angiography and Interventions. I. Results and complications. Cathet Cardiovasc Diagn. 1989;17(1):5-10.</mixed-citation>
      </ref>
      <ref id="ref29">
        <label>29</label>
        <mixed-citation>Johnson LW, Krone R. Cardiac catheterization 1991: a report of the registry of the Society for Cardiac Angiography and Interventions (SCA&amp;I).Cathet Cardiovasc Diagn. 1993;28(2):219–20.</mixed-citation>
      </ref>
      <ref id="ref30">
        <label>30</label>
        <mixed-citation>Kolte D, Spence N, Puthawala M, Hyder O, Tuohy CP, Davidson CB, et al. Association of radial versus femoral access with contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Cardiovasc Revasc Med. 2015;17(8): 546-51.</mixed-citation>
      </ref>
      <ref id="ref31">
        <label>31</label>
        <mixed-citation>Ram P, Horn B, Lo KBU, Pressman G, Rangaswami J. Acute Kidney Injury Post Cardiac Catheterization: Does Vascular Access Route Matter? Curr Cardiol Rev. 2019;15(2):96-101.</mixed-citation>
      </ref>
      <ref id="ref32">
        <label>32</label>
        <mixed-citation>Alkagiet S, Petroglou D, Nikas DN, Kolettis TM. Access-site Complications of the Transradial Approach: Rare But Still There. Curr Cardiol Rev. 2021;17(3):279-93.</mixed-citation>
      </ref>
      <ref id="ref33">
        <label>33</label>
        <mixed-citation>Ullrich H, Münzel T, Gori T. Coronary Stent Thrombosis- Predictors and Prevention. Dtsch Arztebl Int. 2020;117(18):320-26.</mixed-citation>
      </ref>
      <ref id="ref34">
        <label>34</label>
        <mixed-citation>Martín-Aguilar L, Paré-Curell M, Dorado L, Pérez de la Ossa-Herrero N, Ramos-Pachón A, López-Cancio E, et al. Ischaemic stroke as a complication of cardiac catheterisation. Clinical and radiological characteristics, progression, and therapeutic implications. Neurologia (Engl Ed). 2022;37(3):184-91.</mixed-citation>
      </ref>
    </ref-list>
  </back>
</article>
