scholarly journals An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention

2020 ◽  
Vol 14 ◽  
pp. 117954682095179
Author(s):  
Krishnaraj Sinhji Rathod ◽  
Marco Spagnolo ◽  
Mark K Elliott ◽  
Anne-Marie Beirne ◽  
Elliot J Smith ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Optimal Timing ◽  
Post Discharge ◽  
Vessel Disease ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Complete Revascularisation

Background: More than half of the patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) have multi-vessel coronary artery disease. This is associated with worse outcomes compared with single vessel disease. Whilst evidence now exists to support complete revascularisation for bystander disease the optimal timing is still debated. This study aimed to compare clinical outcomes in patients with STEMI and multi-vessel disease who underwent complete revascularisation as inpatients in comparison to patients who had staged PCI as early outpatients. Methods and results: We conducted an observational cohort study consisting of 1522 patients who underwent primary PCI with multi-vessel disease from 2012 to 2019. Exclusions included patients with cardiogenic shock and previous CABG. Patients were split into 2 groups depending on whether they had complete revascularisation performed as inpatients or as staged PCI at later outpatient dates. The primary outcome of this study was major adverse cardiac events (consisting of myocardial infarction, target vessel revascularisation and all-cause mortality). 834 (54.8%) patients underwent complete inpatient revascularisation and 688 patients (45.2%) had outpatient PCI (median 43 days post discharge). Of the inpatient group, 652 patients (78.2%) underwent complete revascularisation during the index procedure whilst 182 (21.8%) patients underwent inpatient bystander PCI in a second procedure. Overall, there were no significant differences between the groups with regards to their baseline or procedural characteristics. Over the follow-up period there was no significant difference in MACE between the cohorts ( P = .62), which persisted after multivariate adjustment (HR 1.21 [95% CI 0.72-1.96]). Furthermore, in propensity-matched analysis there was no significant difference in outcome between the groups (HR: 0.86 95% CI: 0.75-1.25). Conclusions: Our study demonstrated that the timing of bystander PCI after STEMI did not appear to have an effect on cardiovascular outcomes. We suggest that patients with multi-vessel disease can potentially be discharged promptly and undergo early outpatient bystander PCI. This could significantly reduce length of stay in hospital.

Primary percutaneous coronary intervention for ST-elevation myocardial infarction

2018 ◽  
pp. 251-272
Author(s):  
Zulfiquar Adam ◽  
Mark A. de Belder
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Optimal Timing ◽  
Percutaneous Coronary ◽  
Short And Long Term ◽  
St Elevation ◽  
European Society Of Cardiology

This chapter covers primary percutaneous coronary intervention (PPCI), with an investigation of the limitations of the competing thrombolysis procedure, optimal timing, and a discussion of the technical aspects associated with delivering PPCI. Comparing randomized trials that look at differential outcomes in both the short and long term, and covering the European Society of Cardiology guidelines for ST-elevation myocardial infarction treatment, the chapter provides an overview and analysis of the risks and benefits of PPCI.

scholarly journals Bailout Thrombectomy: Its Outcomes in Patients Undergoing Primary Percutaneous Coronary Intervention

2021 ◽  
Vol 15 (5) ◽  
pp. 1765-1767
Author(s):  
Mahboob ur Rehman ◽  
Farhan Faisal ◽  
Amjad Abrar ◽  
Amjad Ali Shah ◽  
Muhammad Shoaib ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Renal Impairment ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Post Procedure ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Group A ◽  
Group B

Aim: To determine the clinical outcomes of patients who received bailout thrombectomy for primary percutaneous coronary intervention. Study Design: Cross-sectional/observational Place & Duration: Study was conducted at Cardiac Centre, Cardiology Department, Pakistan Institute of Medical Sciences (PIMS) Islamabad from January 2020 to December 2020 (for one year). Methods: 200 hundred patients of both genders undergoing primary percutaneous coronary intervention(PPCI)for ST elevation myocardial infarction(STEMI) were analyzed in this study. All patients were divided into two groups. Group A contains 100 patients and received PPCI with bailout thrombectomy and Group B contains 100 patients and received PPCI alone. Informed written consent was taken. Outcomes such as mortality, re-infarction, heart failure, cardiogenic shock, renal impairment, excess bleeding, post procedure stroke and hospital stay were examined and compare between both groups. Results: In Group A there were 53% males and 47% females with mean age 56.45+10.88 years. In Group B 55% were males and 45% were females with mean age 58.35+9.23 years. In Groups A there were more diabetic patients 45% than Group B 32% (p-value 0.005), Group B had more smokers 60%. There was a significant difference between group A and B regarding family history of coronary artery disease 35% vs 20% (p=0.003). In Group A 3% patients were died and in Group B 2% patients were died with no significant difference. Group A patients had more renal impairment 9% vs 5% and stroke 3% vs 1% than Group B. Hospital stay was high in Group A patients 7.12+2.05 vs 5.34+1.02 days of Group B. Conclusion: It is concluded that patients received bailout thrombectomy for percutaneous coronary intervention (PCI) had high rate of comorbidities. There was no significant difference in term of mortality between both groups. However, patients with bailout thrombectomy had more renal impairment and post-procedure stroke. Keywords: ST-segment elevated myocardial infarction, bailout thrombectomy, PPCI, Outcomes

scholarly journals Primary percutaneous coronary intervention in nonagenarians: is it worthwhile?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammed M. N. Meah ◽  
Tobin Joseph ◽  
Wern Yew Ding ◽  
Matthew Shaw ◽  
Jonathan Hasleton ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Final Diagnosis ◽  
Kaplan Meier ◽  
Percutaneous Coronary ◽  
Tertiary Center ◽  
Significant Difference ◽  
St Elevation

Abstract Background Previous studies have demonstrated the feasibility of primary percutaneous coronary intervention (PPCI) in carefully selected nonagenarians. Although current guidelines recommend immediate revascularization in patients with ST elevation myocardial infarction (STEMI) it remains unclear whether PPCI reduces mortality in nonagenarians. The objective of this study is to compare mortality in nonagenarians presenting via the PPCI pathway who undergo coronary intervention, versus those who are managed medically. Methods and results A total of 111 consecutive nonagenarians who presented to our tertiary center via the PPCI pathway between July 2013 and December 2018 with myocardial infarction were included. Clinical and angiographic details were collected alongside data on all-cause mortality. The final diagnosis was STEMI in 98 (88.3%) and NSTEMI in 13 (11.7%). PPCI was performed in 42 (37.8%), while 69 (62.2%) were medically managed. A significant number of the medically managed cohort had atrial fibrillation (23.2% vs 2.4% p = 0.003) and presented with a completed infarct (43.5% vs 4.8% p = 0.001). Other baseline and clinical variables were well matched in both groups. There was a trend towards increased 30-day mortality in the medically managed group (40.6% vs 23.8% p = 0.07). Kaplan Meier survival analysis demonstrated a significant difference in survival by 3 years (48.1% vs 21.7% p = 0.01). This was the case even when those with completed infarcts were excluded (44.3% vs 14.6%, p = 0.01). Conclusion In this series of selected nonagenarians presenting with acute myocardial infarction, those undergoing PPCI appeared to have a lower mortality compared to those managed medically.

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