Clinical characteristics and outcomes of percutaneous coronary intervention in acute St-Elevation MI: A study in AFC Fortis Escort Heart Institute, Khulna, Bangladesh
OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION IN ACUTE ST-ELEVATION MI
Background: Percutaneous coronary intervention (PCI) is an emergent percutaneous catheter intervention in the setting of ST-segment elevations myocardial infarction (STEMI), without previous fibrinolytic treatment. Primary Percutaneous Coronary Intervention has emerged as the therapy of choice in STEMI and selected cases of Non-ST Elevation Myocardial Infarction (NSTEMI). As Percutaneous coronary intervention (PCI) enters its fourth decade of use, it is now the most commonly performed revascularization therapy worldwide. Objective: To find out the clinical Characteristics and Outcomes of Percutaneous Coronary Intervention in ST-Elevation Myocardial Infraction. Methods: In this retrospective study, performed at the Cardiology department AFC Fortis Heart Institute, Khulna, Bangladesh. All patients who underwent PCI for STEMI from January 2018 to December 2019 were enrolled in this study. All the data were collected from the hospital registry and cath lab records. Results: The study showed that out of 175 patients who presented with STEMI, 74.5% were male with an average age of 56.38 years. The mean time of presentation after the onset of symptom/s was 17.5 hours. About 68% of patients presented in less than 12 hours of symptoms onset, 21.7% presented at 12-24 hours of symptoms onset, and 10.3% patients presented late. PCI was done in 88.5% of patients. Almost all patients (98.3%) underwent coronary artery stenting with drug-eluting stents. Multivessel PCI during the index procedure was done in 7 patients. TIMI III flow following PCI was achieved in 97% of cases. The average LVEF at discharge was 44.73%. Among the traditional cardiovascular risk factors, smoking was the commonest. Nearly 50% of the patients smoked while 36% were hypertensive, 27.2% diabetic, 2.6% had known dyslipidemia and 3.6% had a family history of MI. 88.4% of patients presented in Killip class I while 5.6% patients presented in Killip class IV. Anterior wall STEMI was commonest accounting for 53% followed by Inferior wall, 41.8%. Angiography revealed SVD in 36%, DVD in 32.3%, TVD in 28.1%. Left Main Coronary Artery involvement was seen in 5 cases and 1, Left Main angioplasty was done. There were 7 deaths, all after Primary PCI. In-hospital mortality rates for patients presenting with and without cardiogenic shock were 38.46% and 1.59% respectively. The overall mortality rate was 3.98%. Conclusion: This study has reemphasized that PCI is effective in the management of STEMI cases in Bangladesh with improving mortality rates and decreasing complications. Minimizing the delayed presentation after the onset of symptoms should be one of the primes focuses for effective management of STEMI.
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