scholarly journals Hospital outcome of percutaneous coronary stenting in long segment lesions

Author(s):  
M. Bashir Uddin ◽  
A. B. Siddique ◽  
M. Shirajum Munir ◽  
Refaz Uddin ◽  
Abdullah Al Masud ◽  
...  

Background: Coronary heart disease is increasing at an alarming rate among elder people in Bangladesh. For long segment lesion in heart, percutaneous coronary intervention is now a common procedure with great success rate.  The aim of this study was to assess immediate outcome of percutaneous coronary stenting of long segment lesions.Methods: This prospective observational study was conducted at the Department of cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh during the period from January 2005 to December 2006. The sample size was 100 patients undergoing PCI of long and short coronary lesions.Results: No complications found in 82.0% and 88.0% of cases in group I and II respectively. Coronary dissection occurred in 6% and 4% cases in group I and II respectively. ST elevation and pathological Q were 46.0% in pre and 50.0% in post PCI period in group I. In group II patients 48.0% in pre and 52.0% in post PCI period showed ST elevation and pathological Q wave. ST depression and/or T inversion was 18.0% in pre and 16.0% in post PCI period in group I, in group II this value was 22.0% and 14.0% respectively. In group I patients, CK-MB increased from 24.33±7.72 U/l in baseline to 43.30±10.99 U/l 6-8 hrs after procedure and before discharge CK-MB decreased to 31.91±11.17 U/l. In the group II patients, it increased from 25.42±5.84 U/l in baseline to 39.38±6.98 U/l 6-8 hrs after procedure and before discharge CK-MB decreased to 29.64±8.21 U/l.Conclusions: This study concludes that the immediate outcome of long segment coronary stenting is safe and highly effective.

2019 ◽  
Vol 11 (2) ◽  
pp. 98-104
Author(s):  
Fahdia Afroz ◽  
Mir Jamal Uddin ◽  
Md Khalquzzaman ◽  
Mohammad Ullah ◽  
Mohammad Khalilur Rahman Siddiqui ◽  
...  

Background: Primary percutaneous coronary intervention (PPCI) has been performed traditionally by using femoral approach. Transradial approach has become increasingly popular as it is likely to be less complicating, more comfortable and relatively cost effective having mortality and morbidity benefits. The aim of the study was to compare the in-hospital outcomes of transradial PPCI with that of transfemoral route. Methods: A total of 80 patients with ST elevation myocardial infarction (STEMI) who underwent PPCI were enrolled in the study. Patients were divided in two groups. Group-I: transradial PPCI; and Group-II: transfemoral PPCI. All patients were followed up during the period of hospital stay and adverse outcomes were observed and compared between the groups. Results: The result showed that bleeding took place in 2.5% patient of Group-I and 15% patients of Group- II. Vascular complications occurred in 2.5% and 12.5% patients of Group-I and Group-II, respectively. In Group-II, 7.5% patients died with none in Group-I. In Group-II, 37.5% patients experienced some sort of adverse outcomes whereas only 15% of the patients of Group-I did have such experiences (p<0.05). Bleeding and vascular complications were significantly more in Group-II (p<0.05). The mean hospital stay time was significantly lower in Group-I (p<0.001). Conclusions: Transradial PPCI is safer than transfemoral approach in respect of procedural and post procedural complications including bleeding, vascular complications and mortality. So, transradial approach may be an attractive alternative to conventional transfemoral approach and can be practiced routinely for PPCI. Cardiovasc. j. 2019; 11(2): 98-104


2014 ◽  
Vol 7 (1) ◽  
pp. 11-16
Author(s):  
MM Alam ◽  
M Ali ◽  
MSR Patwary ◽  
SMA Romel ◽  
MS Kabir ◽  
...  

Background: Side branch occlusion is a well known complication of percutaneous coronary intervention. Although occlusion of small side branches is well tolerated, occlusion of larger side branches may cause more serious complications. After PCI the incidence of complications in patients with compromised side branches smaller than 2 mm is small. Compromising side branches larger than 2 mm can be accompanied by clinical outcomes as non Q-wave MI. This study was undertaken to assess the in-hospital outcomes of compromised small (<2mm) side branch after percutaneous coronary intervention. Methods: This cross sectional analytical study was carried out in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka during the period of September 2011 to June 2012. A total of 100 consecutive patients with coronary artery disease who underwent elective PCI were included in the study. Study patients were divided into two groups on the basis of presence of compromised small (< 2 mm) side branch. In Group- I, small (< 2 mm) side branch were compromised after PCI and in Group- II, side branches were patent after PCI, with 50 patients in each group. In-hospital outcome were evaluated in both groups. Result: There were no significant differences of the baseline clinical demographics between two groups. Post PCI angina was higher in group I than group II (10.0% vs. 9.0%). Non ST elevation myocardial infarction and significant arrhythmia was identical in both groups (2.0% vs. 2.0%) but hypotension was more in group II than group I (4.0% vs. 2.0%). The findings were statistically insignificant between the study groups. There was no mortality, emergency CABG within 24 hours, ST elevation myocardial infarction, cardiogenic shock or acute left ventricular failure during their hospital course in either group. Conclusion: The present study concluded that compromised small (<2mm) side branch after percutaneous coronary intervention was not associated with adverse in-hospital outcome. DOI: http://dx.doi.org/10.3329/cardio.v7i1.20795 Cardiovasc. j. 2014; 7(1): 11-16


2012 ◽  
Vol 5 (1) ◽  
pp. 37-43
Author(s):  
ABMM Alam ◽  
M Moniruzzaman ◽  
MB Alam ◽  
N Islam ◽  
F Khatoon ◽  
...  

Background: CIN has gained increased attention in the clinical setting, particularly during cardiac intervention but also in many other radiological procedures in which iodinated contrast media are used. There is at present good clinical evidence from well-controlled randomized studies that CIN is a common cause of acute renal dysfunction.Methodology: This was a prospective study conducted among the patients who underwent coronary angiography and percutaneous coronary intervention in the Department of Cardiology, Dhaka Medical College Hospital during January 2010 to December 2010. A total of 111 patients age range from 25 to 75 years were included in the study. Serum creatinine level at baseline and at the end of 48 hours was done in all these patients. Study population was divided into two groups according to development of acute kidney injury (AKI). Group-I = AKI, Group II = Not developed AKI. Results: AKI developed 11.7% of the study patient. DM and Preexisting renal insufficiency were significantly higher in group I patients. HTN was (61.5% Vs 44.9%) higher in group I but not significantly. History of ACE inhibitor/ARB, NSAID intake and LVEF <40% were significantly higher in group I patients. The mean±SD volume of CM (Contrast Media) were 156.9±44.8 ml and 115.4±30.0 ml in group I and group II respectively, which was significant. The mean±SD of serum creatinine after 48-72 hours of CAG/PCI was 1.4±0.37 mg/dl and 1.1±0.2 mg/dl in group I and group II respectively. The serum creatinine level increased significantly (p<0.05) after 48-72 hours of CAG/PCI in group I. In group II, S. creatinine level increased but not significant (p>0.05). Impaired renal function was found 76.9% and 2.0% in group I and group II respectively. DM, HTN, preexisting renal insufficiency, ACE inhibitor/ARB, NSAIDs, contrast volume (>150 ml), eGFR (<60 ml/min/ 1.73m2) and LVEF (<40%) are significantly (p0.05) associated for CIN development.Conclusion: CIN is an iatrogenic but preventable disorder results from the administration of contract media. Although rare in the general population, CIN occurs frequently in patients with underlying renal dysfunction and diabetes. In patients with pre angiographic normal renal function, the prevalence is low but in pre-existing renal impairment it may pose a serious threat. Thus risk factors are synergistic in their ability to predispose to the development of CIN. A careful risk-benefit analysis must always be performed prior to the administration of contrast media to patients at risk for CIN. DOI: http://dx.doi.org/10.3329/cardio.v5i1.12227 Cardiovasc. j. 2012; 5(1): 37-43


1970 ◽  
Vol 4 (1) ◽  
pp. 32-41 ◽  
Author(s):  
MM Haque ◽  
M Ullah ◽  
MS Alam ◽  
SU Ulabbi ◽  
R Uddin

Background:To accurately stratify patients undergoing PCI, according to their risk of future adverse events, a quest for risk predictors is ongoing worldwide. But only a few powerful and independent predictors of early and late major adverse cardiovascular events have been found. These include traditional risk factors, such as acute coronary instability, diabetes mellitus, reference vessel diameter, and lesion and/or stent length. This study was undertaken to find out the relationship between pre-procedural CRP level with in-hospital (both procedural and before discharge) complications. Materials & methods: This prospective study was carried out in National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period of June,2006 to May,2007. After fulfilling the exclusion criteria, 100 consecutive patients were selected as sample those underwent percutaneous coronary intervention. C-Reactive protein (CRP) was measured in all patients before the procedure. Those having pre-procedural CRP level <.3 mg/dl was labeled as group-I and those with CRP level e”.3 mg/dl was labeled as group-II. In hospital outcomes were compared between two groups after percutaneous coronary intervention. Results: During the procedure, higher rate of complications (10.0% vs 26.0%) were noted in group- II, which was statistically significant. Among many complications abrupt occlusion, threatened (dissection and new thrombus) and residual stenosis were significantly high in group-II. Other complications like coronary spasm, arrhythmia, side branch occlusion, heart failure, shock and no reflow were also high in higher level of CRP level patients but statistically not significant. Inhospital complications were also significantly high (10.0% vs 28.0%) in patients with higher level of CRP ie. Group-II. Among other complications recurrence of ischemia and myocardial infarction developed at significantly higher rate in group-II. Post procedural CK-MB rose significantly (18.0% vs 36.0%) in patients with higher level of CRP (group-II) in comparison to normal level of CRP patients (group-I). When the in-hospital complications were distributed among three tertiles of CRP, it was observed that complications were proportionately high with increasing level of CRP. Conclusions: Many studies, conducted abroad, have suggested that factors like gender, extreme age, diabetes, multi-vessel disease and lesion characteristics adversely influence PCI outcome. But in this study, multivariate regression analysis has shown that elevated level of CRP is even stronger independent predictor of PCI outcome. Keywords: C-Reactive Protein; In hosital outcome; PCI. DOI: http://dx.doi.org/10.3329/cardio.v4i1.9387 Cardiovasc. J. 2011; 4(1): 32-41


2019 ◽  
Vol 34 (1) ◽  
pp. 5-10
Author(s):  
Md Shariful Islam ◽  
Md Afzalur Rahman ◽  
Abdul Wadud Chowdhury ◽  
Mohsin Ahmed ◽  
Kajal Kumar Karmakar ◽  
...  

Background: Limited contemporary data exist regarding the impact of SYNTAX score on procedural outcomes undergoing primary percutaneous coronary intervention(PCI) in acute STEMI patients. Objectives: To evaluate the significance of the SYNTAX score for predicting procedural outcome after primary PCI in patient with acute STEMI. Methods: This perspective observational study was conducted in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from September, 2015 to September, 2016. 42 patients with acute STEMI who underwent primary PCI were considered for the study. But 2 patients were excluded from the study due to failure of primary PCI. The patients were divided into two groups: Group I (low Syntax score d”22) and Group II (high Syntax score > 22). The Syntax score of all patients were calculated from an initial coronary angiogram before primary PCI. Procedural outcome was observed in between two groups. Results: Among study patients 57.5% were in SYNTAX score d”22 (Group I) and 42.5% were in SYNTAX score >22 (Group II). Among traditional cardiovascular risk factors diabetes was significantly more prevalent in the Group II than Group I ( 82.4% vs 34.8%, p  0.003). Angiographic profile revealed maximum (69.6% vs 17.6%) culprit lesion in LAD artery in Group I and maximum culprit lesion (64.7% vs 21.7%) in RCA in Group II, these were the statistically significant between Group I and Group II (P<0.05). The high SYNTAX score group had lower ejection fraction (47.8±5.1 vs. 54.4±4.3, p= 0.04), lower TIMI flow 3 rate (76.47% vs 91.3%, p= 0.03 ) greater rate of MACE (29.4% vs. 4.3%, p=0.041), lower procedural success rate ( 76.47 vs. 91.3%, p= 0.046) compared to the low SYNTAX score group. ROC curve showed 77% sensitivity and 32% specificity for SYNTAX score when cut off value was 22 Performance test of SYNTEX score in the setting of Primary PCI outcome showed positive predictive value 83%. Conclusions: SYNTAX score was an independent variable that can predict procedural outcomes Bangladesh Heart Journal 2019; 34(1) : 5-10


2018 ◽  
Vol 33 (1) ◽  
pp. 22-27
Author(s):  
Tariq Ahmed Chowdhury ◽  
Mustafizul Aziz ◽  
Iftekhar Alam ◽  
Abuduz Zaher ◽  
Sayed Azizul Haque ◽  
...  

This prospective observational study was carried out in the Department of Cardiology of national institute of cardiovascular diseases (NICVD), Dhaka to assess the safety of low molecular weight heparin (LMWH) in patients undergoing percutaneous coronary intervention (PCI). Safety of low molecular weight heparin in comparison to unfractionated heparin (UFH) was observed in this study. In total data from 100 patients undergoing elective PCI was evaluated. Among them 50 patients in group I received I mg/kg intra-arterial LMWH and rest in group II received UFH. Demographic profile of individuals in both groups was almost similar. There was no significant difference in major coronary risk factors between the two groups. Patients were monitored during their stay in hospital for any complications like bleeding, haematoma, myocardial infraction and death. No death was observed in any group. Minor bleeding in group I and II (6% vs 105), Major bleeding (2% vs4%) and haematoma (6% vs 10%). Myocardial infraction no incidence in group I and 4% in group II. So complications was more prevalent in group II who were treated with UFH, but those were not statistically significant. The intra-arterial administration of LMWH in patients undergoing PCI is safe. The risk of acute and sub-acute coronary events and bleeding complications are similar in both groups and in hospital outcome there is less complication with LMWH used during PCI.Bangladesh Heart Journal 2018; 33(1) : 22-27


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Osama A. Amin ◽  
Ahmed Alaarag

Abstract Background This work aimed to assess the safety of Ramadan Fasting following the Percutaneous Coronary Intervention. Methods In our two centers’ Prospective Cohort Study, We included 303 patients who had successful Percutaneous Coronary Intervention before the first day of Ramadan. We advised the patients that recent Percutaneous Coronary Intervention could be a valid excuse for not fulfilling Ramadan Fasting. However, many patients intended to fast the following Ramadan, and we included them in the fasting Group I. We added the patients who decided not to fast the following Ramadan as a control Group II. We followed all the patients during Ramadan and for 6 months after Ramadan. Results The demographic data of both groups and the complexity of the coronary anatomy showed no statistically significant difference. Group I (n = 153) showed a statistically significant difference in the incidence of Major Adverse Cardiac Events compared to Group II with a P value (0.005). The logistic multivariate regression analysis showed that the duration from index PCI till the start of RF, SYNTAX score > 22, and Complex procedure were independent predictors of Major Adverse Cardiac Events in the fasting Group I with {P = 0.001, OR (2.302), P = 0.026, OR (2.419), and P = 0.032 OR (1.952)}, respectively. Major Adverse Cardiac Events in Group I occurred mainly during Ramadan Fasting, with 19 patients having Major Adverse Cardiac Events during Ramadan and four patients during the remaining of the follow-up period. The Receiver Operating Characteristic curve analysis showed the decline of the incidence of Major Adverse Cardiac Events after 90 days from Percutaneous Coronary Intervention till the start of Ramadan Fasting with Sensitivity and specificity (90% and 65%), respectively. Conclusions We suggest that low-risk patients with a normal systolic function who underwent Percutaneous Coronary Intervention may safely fast Ramadan. At the same time, Ramadan Fasting during the first 3 months following the Percutaneous Coronary Intervention may not be safe.


2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A Santoso ◽  
A Nofanda Putra ◽  
D A F S A H Arifa Yuzar

Abstract Background Some STEMI patients still suffers adverse outcomes though they undergo optimal management, including primary PCI. Plasma PCSK9 is deemed to  have a role in that residual risk. Our knowledge on the association between plasma PCSK9 level and MACCE in STEMI is still limited. Purpose The aim of this study is to evaluate the association between plasma PCSK9 level during admission with MACCE in STEMI who undergo primary PCI. Methods This was a prospective observational study, recruited 239 patients with STEMI who were treated with primary PCI and assayed for PCSK9 level using ELISA technique.  MACCE and other supportive data were taken from the medical records and telephone follow-up. Results  There were 28 study participants who experienced MACCE in 30 days. However, survival analysis did not show a significant association between plasma PCSK9 level and MACCE in 30 days. The hazard ratio for MACCE between the third tertile and the second tertile of plasma PCSK9 level was 1.466 (95%CI 0.579-3.714) and between the first tertile and the second tertile was 1.257 (95%CI 0.496-3.185). Conclusion  Plasma PCSK9 levels was not associated with MACCE in STEMI patients treated with primary PCI.


2018 ◽  
Vol 33 (2) ◽  
pp. 121-125
Author(s):  
Md Shariful Islam ◽  
Md Afzalur Rahman ◽  
Abdul Wadud Chowdhury ◽  
Sayed Nasir Uddin ◽  
Nupur Kar ◽  
...  

Background: Limited contemporary data exist regarding the impact of SYNTAX score on in-hospital outcomes undergoing primary percutaneous coronary intervention(PCI) in acute STEMI patients. Objectives: To evaluate the significance of the SYNTAX score for predicting in- hospital outcome after primary PCI in patient with acute STEMI. Methods: This cohort study was conducted in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from September, 2015 to September, 2016. 42 patients with acute STEMI who underwent primary PCI were considered for the study. But 2 patients were excluded from the study due to failure of primary PCI. The patients were divided into two groups: Group I (low SYNTAX score d”22) and Group II (high Syntax score > 22). The Syntax score of all patients were calculated from an initial coronary angiogram before primary PCI. In-hospital outcome was observed in between two groups. Results: Among traditional cardiovascular risk factors diabetes was significantly more prevalent in the Group II than Group I ( 82.4% vs 34.8%, p  0.003). Angiographic profile revealed maximum (69.6% vs 17.6%) culprit lesion in LAD artery in Group I and maximum culprit lesion (64.7% vs 21.7%) in RCA in Group II, these were the statistically significant between Group I and Group II (P<0.05). The high SYNTAX score group had lower TIMI 3 (76.47% vs 91.3%, p  0.03) compared to the low SYNTAX score group. But there were no significant difference in complications as arrhythmia (2.5% vs 0%), cardiogenic shock (2.5% vs 0%), heart failure (5% vs 2.5%) and mortality (5%vs 0%) between high and low SYNTAX score. Multivariate logistic regression analysis revealed SYNTAX score (OR = 5.95, p  0.001) was an independent predictor of in-hospital outcome in patients under going primary PCI. Performance test of SYNTEX score in the setting of Primary PCI outcome showed positive predictive value 83%. Conclusions: SYNTAX score was an independent variable that can predict in-hospital outcomes of patients with acute STEMI undergoing primary PCI. Bangladesh Heart Journal 2018; 33(2) : 121-125


2021 ◽  
Author(s):  
Shwan O. Amen ◽  
Banan Q. Rasool ◽  
Alaa Rashid ◽  
Sara S. Shakir ◽  
Parez M. Qadr ◽  
...  

Abstract Background: The rise of Primary Percutaneous Coronary Intervention (PPCI) procedure as an option for treating Coronary Artery Diseases demands addressing a variety of concerns in the recovery period and afterward including fasting the Ramadan month in the countries with the prevailing Muslim population. Therefore this study aims to assess the ability and the safety of fasting among patients who underwent PPCI within two specified periods.Method: This study was a prospective observational study with a sample size of 200 consecutive patients that have been divided into two groups based on the duration of their last PCI for an attack of Acute Myocardial Infarction (AMI). The patients were admitted to the Causality Department of the Surgical Specialty Hospital-Cardiac Center, Erbil/Iraq. The studied data have been analyzed using the Statistical Package for Social Science version 25 (SPSS), and a P-value of ≤0.05 was considered statistically significant.Results: The proportion of fasting and non-fasting patients showed a significant association with the duration of their last PCI procedure with a P-value of 0.001 as 14% in Group I (patients with less than 6 weeks duration post-PCI) successfully fasted the month while it was 54% in Group II (Patients with more than 6 weeks duration post PCI). Among our findings, there were significant associations with P-values of 0.001 between post-PCI symptoms and Ramadan fasting. In regards to NYHA classifications assessment, Group I had a higher proportion of patients classified as Class III and Class IV compared to Group II with a significant P-value of 0.001 with proportions of class III classification in Group I of 14.3% among fasting, 17.1% among non-fasting, and 58.3% among those who could not continue their fasting while in Group II, the proportions showed 3.7% among fasting, 6.7% among non-fasting, and 0% among those who could not continue their fasting.Conclusion: We discourage fasting among patients who have undergone Percutaneous Coronary Intervention within the first 6 weeks, as well as patients who have NYHA class III and above as they are highly liable for deterioration and can not continue their fasting.


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