"Coronary artery disease is the most common form of heart disease and is responsible for 15 million deaths worldwide. Nine million of these deaths occur in developing countries while millions of other victims remain alive yet hopelessly crippled." This was stated by Dr Sajid Dhakam, Assistant Professor and Head of Cardiology Section at Aga Khan University Hospital (AKUH), Karachi, while giving a presentation on  'Coronary Artery Disease'. Dr Dhakam was speaking at 'Signs, Symptoms and Care' programme held on February 15, 2005 at Intercontinental Hotel, Abu Dhabi.

Explaining the process of narrowing of coronary arteries, Dr Dhakam said that "this is caused by deposits of cholesterol-rich material in blood vessels. Formation of a clot on top of these blockages leads to a heart attack and 50 per cent of patients who suffer the heart attack do not survive; in fact they do not even make it to hospital."

There are multiple risk factors, Dr Dhakam continued, which are responsible for the formation of blockages in arteries of the heart.  "These include age, male gender, positive family history, diabetes mellitus, high blood pressure, high cholesterol levels, smoking, lack of exercise and obesity. Such risk factors may be modified to prevent and control the disease," he informed the audience.

Coronary angiogram is the gold standard for diagnosis of coronary heart disease and provides vital information for planning management. "It is a low-risk procedure and the overall risk of major and minor complications is less than 0.5 per cent," he disclosed. Coronary angioplasty is a therapeutic procedure which involves opening of the blockages with a balloon. "It is not a surgical procedure. After the opening of the artery, metallic stents are used, which help in keeping the arteries patent," he said, adding that new medicated stents which are now available reduce the rate of re-stenosis rate or recurrence of blockage.

Dr Saulat Fatimi, Assistant Professor and Consultant Cardiothoracic Surgeon at AKUH, presented a paper titled 'Bypass Surgery versus Balloon Angioplasty: which one is better for you?' Dr Fatimi said that new breakthroughs in surgical procedures are redefining cardiac surgery and dramatically improving patient outcomes. "Bypass surgery is recommended if the blockages are severe and widespread; i.e. if three arteries are blocked or the blockages are at critical branching points," he maintained

Dr Fatimi said that coronary artery bypass surgery in the 21st century is considered to be very safe with a success rate over 98 per cent in most cases. "However, angioplasty might be recommended for a patient with such blockages if age or multiple co-morbidities rule out major surgery. Usually, angioplasty is recommended for one or two vessel blockages without involvement of the left main coronary artery," he explained.

If treatment is needed for serious coronary artery disease - blockages in the arteries supplying blood to the heart muscle itself - the patient will generally face one of two prospects. "Either a surgeon will graft a section of artery or vein in place to carry blood around the blockage, a procedure known as coronary artery bypass surgery (CABG), or an interventional cardiologist will reopen the blockage from inside the artery (angioplasty), usually by inflating a tiny balloon to flatten the obstructing plaque," he said.

Dr Fatimi also said that new angioplasty technologies, such as smaller and more flexible catheters, atherectomy tools which cut away and remove plaque, and adjunct devices like stents that hold blood vessels open following angioplasty, continue to evolve. "As they do, the grey area between what is a surgical or non-surgical patient continues to grow," he said.

"In my view, patients should obtain an initial treatment recommendation or second opinion from a cardiovascular speciality group, which includes both cardiovascular surgeons and interventional cardiologists. Unfortunately, this remains the exception rather than the rule," he concluded. 

Earlier, Ms Talaat Tyabji, Director, Marketing and Public Affairs, AKU, welcomed the guests and described AKUH as a philanthropic, not-for-profit institution that is committed to the delivery of quality health care to all segments of society. "At present, 504 beds are available at this academic medical centre and the Hospital has become a major referral centre in Pakistan that regularly receives patients from the Middle East, Bangladesh and East Africa," she added.

AKUH's Representative Office in Dubai was inaugurated in May 2002 and is located at the Oud Metha Office Complex, providing convenience and easy access to AKUH's high-quality, cost-effective services to patients in the United Arab Emirates.

As part of its outreach programme and societal commitment of creating awareness of early diagnosis and timely treatment, AKUH has organised over 160 'Signs, Symptoms and Care' programmes in Karachi, Hyderabad and the UAE, benefiting more than 35,000 people.