Evaluation of secondary prevention in Egyptian patients after primary percutaneous coronary intervention

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
NAGWA Thabet ◽  
LABIB Dina ◽  
AHMED Samir ◽  
M Hosny ◽  
AHMED Hassan ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Secondary Prevention ◽  
Primary Percutaneous Coronary Intervention ◽  
Smoking Status ◽  
Multivariable Analysis ◽  
Coronary Intervention ◽  
Cardiac Events ◽  
Upper Egypt ◽  
Preventive Cardiology ◽  
Percutaneous Coronary

Abstract Funding Acknowledgements Type of funding sources: None. Background Effective secondary prevention after acute coronary syndromes is critical to reducing the risk of a subsequent cardiovascular event.  Adherence to secondary prevention is disappointingly low worldwide, with no data in Upper Egypt.  Purpose and methods  We sought to determine the prevalence of adherence to secondary preventive among patients who underwent primary percutaneous coronary intervention (PPCI) in a tertiary centre in Upper Egypt from 2014-2016 (n = 468). Results  Our cohort included 468 patients, mean age  at STEMI was 55.7 ± 11.2 years; 79% males. Smoking, diabetes mellitus (DM), dyslipidemia, obesity and hypertension were 62%, 42%, 39%, 38% and 34% respectively. Median follow-up duration (IQR) was 703 (613-830) days. Table 1 shows the prevalence of adherence secondary prevention. Re-myocardial infarction, unstable angina, repeated hospital admission was 4.9%, 5.1%, 14% respectively.  Revascularizations were 8.1% and total ischemic complications  were 18%. The major adverse cardiac events MACEs were 24%. DM and hypertension were significant predictors of MACEs on univariable and multivariable analysis (multivariable ORs [95% CIs]: 1.685 [1.002 -2.833] and 1.764 [1.033-3.012], respectively).  Conclusion  Adherence to secondary prevention after PPCI is sub-optimal in Upper Egypt. We need to raise the standard of preventive cardiology care through more effective primary and secondary prevention programs, to reduce morbidity and mortality. Risk factor Target level Number (%) Diabetes HbA1c <7% 280(62) Blood pressure <140/90 295(63) Smoking cessation in smokers Complete cessation 122 (43) Smoking status No smoking 301(65) Physical activity Walking at least 30 minutes 5 days/week 301(60) Body mass index <25 kg/m2 101(22) Waist circumference <102 cm in males, <88 cm in females 164(36) Diet Low salt and fat, adequate fruits and vegetables 268 (57) Lipids LDL < 70 gm/dL 93(26)

Frequency and impact of slow flow / no flow in primary percutaneous coronary intervention

2021 ◽  
Author(s):  
Ghazanfer Ali Shah ◽  
Tooba malik ◽  
Sadaf Farooqi ◽  
Salman Ahmed ◽  
Khadijah Abid
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Smoking Status ◽  
Coronary Intervention ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Antegrade Flow

Objectives: To determine the frequency of slow/no flow in primary percutaneous coronary intervention, to know the clinical and angiographical predictors of the phenomenon, and to investigate the immediate impact of slow/no flow on hemodynamics. Method: The cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from June 2018 to July 2019, and comprised patients presenting with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention. Demographic and clinical details of the patients were recorded. The antegrade flow was assessed and determined using the thrombolysis in myocardial infarction criterion. Patients were assessed for the occurrence, predictors and impact of slow/no flow. Data was analysed using SPSS 21. Results: Of the 559 patients, 441(78.9%) were males. The overall mean age of the sample was 55.86±11.07 years. Angiographical slow/no flow during the procedure occurred in 53 (9.5%) patients, while normal flow was achieved in 506(90.5%). The thrombolysis in myocardial infarction grade in the affected patients was 0 in 10(1.8%), 1 in 15(2.7%), and 2 in 28(5%) patients. Smoking status, Continuous...

scholarly journals Impaired thrombolytic status predicts adverse cardiac events in patients undergoing primary percutaneous coronary intervention

2017 ◽  
Vol 117 (03) ◽  
pp. 457-470 ◽  
Author(s):  
Keith Sullivan ◽  
David Wellsted ◽  
Christos Christopoulos ◽  
Mohamed Farag ◽  
Diana A. Gorog
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Primary Percutaneous Coronary Intervention ◽  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Pharmacological Intervention ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary

SummaryAntithrombotic medications reduce thrombosis but increase bleeding. Identification of ST-elevation myocardial infarction (STEMI) patients at risk of recurrent thrombosis could allow targeted treatment with potent antithrombotic medications, with less potent agents in others, to reduce bleeding. Conventional platelet function tests assess platelet reactivity only, yet there is increasing evidence that endogenous thrombolytic potential determines outcome following thrombus initiation. We investigated whether assessing both platelet reactivity and endogenous thrombolysis, could identify STEMI patients at high-risk of recurrent thrombotic events. Thrombotic status was assessed in STEMI patients, before and after primary percutaneous coronary intervention (PPCI), at discharge and at 30 days; with 12 months’ followup. The time to form an occlusive thrombus under high shear (occlusion time, OT), and time to restore flow by endogenous thrombolysis (lysis time, LT) was measured using the point-of-care Global Thrombosis Test (GTT) in the cardiac catheterisation laboratory. Impaired endogenous thrombolysis (prolonged LT ≥ 3000 s), seen in 13 % patients pre-PPCI, was related to major adverse cardiac events, MACE (HR: 3.31, 95 %CI: 1.02–10.78, p = 0.045), driven by cardiovascular death (HR: 4.17, 95 %CI: 0.99–17.51, p = 0.05). Enhanced (rapid) endogenous thrombolysis (LT < 1000 s) was associated with spontaneous reperfusion, ST-segment resolution and Thrombolysis In Myocardial Infarction 3 flow pre-PPCI. Baseline OT was shorter in those with MACE (especially recurrent myocardial infarction and stroke) than those without (253 ± 150 s vs 354 ± 134 s, p=0.017). Endogenous thrombolysis, when impaired, is associated with increased cardiovascular risk, and when enhanced, with spontaneous reperfusion. Endogenous thrombolysis may be a novel target for pharmacological intervention, and allow targeting of potent antithrombotic medications to high-risk patients.

scholarly journals Clinical outcomes following primary percutaneous coronary intervention for ST-elevation myocardial infarction according to sex and race

2017 ◽  
Vol 8 (3) ◽  
pp. 264-272 ◽  
Author(s):  
Arvindra Krishnamurthy ◽  
Claire Keeble ◽  
Natalie Burton-Wood ◽  
Kathryn Somers ◽  
Michelle Anderson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Cardiovascular Risk ◽  
Clinical Outcomes ◽  
South Asian ◽  
Primary Percutaneous Coronary Intervention ◽  
Multivariable Analysis ◽  
Coronary Intervention ◽  
Percutaneous Coronary

Background: Female sex and South Asian race have been associated with poor clinical outcomes following primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) but remain understudied in large real-world series. We therefore investigated the association of sex and race with clinical outcomes following PPCI. Methods: We conducted a prospective study of all patients undergoing PPCI for STEMI between January 2009 and December 2011 at a large UK cardiac centre. Clinical characteristics and outcomes were compared according to sex and race using Chi-square test, independent samples Student’s t-test and Mann–Whitney U-test. Primary and secondary outcomes were 12-month major adverse cardiovascular events (MACEs) – defined as all-cause mortality, myocardial infarction and unplanned revascularization, analysed using Cox proportional hazard models adjusting for cardiovascular risk factors. Results: Three thousand and forty-nine patients were included. Women ( n=826) were older than men ( n=2223) (median age 69 vs. 60 years, p <0.01). Mortality (hazard ratio 1.48 (1.15–1.90)) and MACE (hazard ratio 1.40 (1.14–1.72)) were higher in women in univariable analysis. However, there were no significant sex-differences in mortality or MACE after age-stratification alone. Multivariable analysis also showed no significant differences in outcomes between sexes. South Asians ( n=297) were younger but had a higher prevalence of most risk factors than White patients ( n=2570). Mortality and MACE did not differ significantly between South Asian and White patients in univariable or multivariable analysis. Conclusion: MACE and mortality was not greater in women, or in South Asian patients following PPCI after adjustment for cardiovascular risk factors including age, which was most strongly associated with both outcomes.

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