Measuring Adverse Cardiovascular Outcomes (MACE) in diabetic vs nondiabetic Primary PCI (PPCI) patients suffering from STEMI in PIC, Lahore
Keywords:Primary PCI, Acute STEMI, MACE.
All over the world, particularly in developing countries, Coronary Artery Diseases (CADs) are a major cause of significant morbidity and mortality. Primary PCI (PPCI) is the standard of emergency care in patients suffering from STEMI. The major cardiovascular outcomes (MACE) may be different in diabetic and nondiabetic patients.
This article aims at comparing major adverse cardiovascular outcomes in diabetic and nondiabetic STEMI patients going through pPCI.
Descriptive case series
Emergency Department, Punjab Institute of Cardiology (PIC), Lahore.
A total of 245 patients were included out of which 85 were diabetic and 160 were nondiabetic. Post-PPCI in-hospital outcomes were recorded: mortality, cerebrovascular accident, acute and subacute stent thrombosis, heart failure, acute kidney injury and arrhythmias.
With mean age of 50.3 ± 9.7 years; mean BMI of 28.0 ± 2.0 kg/m2, risk factors included hypertension (73), family history of IHD (23) and smoking (81). Post-PPCI in hospital outcomes in 85 diabetics were as follows: mortality 0, heart failure in 1 (1.18%), acute stent thrombosis 0; acute kidney injury in 8 patients (9.41%). Among 160 nondiabetic patients, post PPCI outcomes were as follows: mortality 2 (1.25%), heart failure 4 (2.5%), acute stent thrombosis 1 (0.6%) and acute kidney injury 6 (3.75%). The only significant association among PPCI following STEMI and in-hospital outcomes was with acute kidney injury (P = 0.069).
For acute STEMI, following the primary percutaneous intervention (PPCI), results among diabetic and nondiabetic patients seem to be favorable in terms of major undesirable outcomes and possible to achieve in PIC, Lahore. PPCI is associated with larger success rate, low mortality rate and complication rates. The hospital's experiences and results can be very valuable in establishing PPCI networks in our nation.
Primary PCI, Acute STEMI, MACE.
Roth G, Huffman M, Moran A, Feigin V, Meh G, Naghavi M, et al. Global and Regional Patterns in Cardiovascular Mortality from 1990 to 2013. Circulation. 2015;132(17):1667-78.
Bandara R, Medagama A, Munasinghe R, Dinamithra N, Subasmghe A, Herath J. Management and outcomes of acute ST-segment-elevation myocardial infarction at a tertiary care hospital in Sri Lanka: an observational study. BBMC Cardiovascular Disorders (BioMed Central). 2015;15:1-7.
Rahman M, Afrin S, Islam M, Shahriar M, Zahid M, Badiuzzaman M. Comparison of St-segment resolution influencing in hospital outcome after primary percutaneous coronary intervention and fibrinolysis (with streptokinase) in patients with acute ST-segment elevation myocardial infarction - Original article. Bangladesh J Med Sci. 2016;15:252-6.
Peiyuan H, Jingang Y, Haiyan X, Xiaojin G, Ying X, Yuan W. The Comparison of the Outcomes between Primary PCI, Fibrinolysis, and No Reperfusion in Patients >/= 75 Years Old with ST-segment Elevation Myocardial Infarction: Results from the Chinese Acute Myocardial Infarction (CAMI) Registry. PlosOne. 2016;11:e0165672.
Petroni T, Zaman A, Georges J, Hammoudi N, Berman E, Segev A. Primary percutaneous coronary intervention for ST elevation myocardial infarction in nonagenarians. Heart. 2016;102:1648-54.
Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenland K, et al. Heart disease and stroke statistics. Circulation. 2007;115(5):e69-171.
Farman M, Sial J, Khan N, Rizvi S, Saghir T, Zaman K. Outcome of primary percurtaneous coronary intervention at public sector tertiary care hospital in Pakistan. J Pak Med Assoc. 2011;61:575.
Kim M, Jeong M, Kim S, Hong Y, Kim J, Ahn Y. Current status of coronary intervention in patients with ST-segment elevation myocardial infarction and multi-vessel coronary artery disease. Korean Circulation J 2014;44:31.
Steg PG, James SK, Badano DALP, Blömstrom-Lundqvist C, Borger MA, Mario CD, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J. 2012;33:2569-619.
Thomas MP, Bates ER. Update on primary PCI for patients with STEMI, . Trends in Cardiovascular Medicine. 2017;27(2):95-102.
Mehran R, Pocock S, Nikolsky E, Clayton T, Dangas G, Kirtane A. A risk score to predict bleeding in patients with acute coronary syndromes. J Am Coll Cardiol. 2010;55:2556-66.
Pancholy S, Shantha G, Patel T, Cheskin L. Sex Differences in Short-term and Long-term All-Cause Mortality Among Patients With ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Intervention: A Meta-analysis. JAMA Intern Med. 2014;174(11):1822-30.
Roger V, Go A, Lloyd-Jones D, Benjamin E, Berry J, Borden W. Executive summary: heart disease and stroke statistics - 2012 update: a report from the American Heart Association. Circulation. 2012;125:188–97.
Keeley E, Boura J, Grines C. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review of 23 randomised trials. Lancet. 2003;361:13-20.
Andersen H, Nielsen T, Rasmussen K, Thuesen L, Kelbaek H. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003;349:733-42.
Steg P, Goldberg R, Gore J. Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE). Am J Cardiol 2002;90:358-63.
Gibson C. NRMI and current treatment patterns for ST-elevation myocardial infarction. Am Heart J. 2004;148(S29-S33).
Subban V, Lakshmanan A, Victor S. Outcome of primary PCI – an Indian tertiary care center experience. Indian Heart J 2014;66:25-30.
Gershlick AH, Banning AP, Myat A, Verheugt FWA, Gersh BJ. Reperfusion therapy for STEMI: is there still a role for thrombolysis in the era of primary percutaneous coronary intervention? The Lancet. 2013;382(9892):624-32.
Johansson S, Rosengren A, Young K. Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review. BMC Cardiovasc Disord. 2017;17(53).
Rapsomaniki E, Thuresson M, Yang E, Blin P, Hunt P, Chung S, et al. Using big data from health records from four countries to evaluate chronic disease outcomes: a study in 114 364 survivors of myocardial infarction. Eur Heart J Qual Care Clin Outcomes. 2016;2(3):172-83.
Dubey G, Verma SK, Bahl VK. Primary percutaneous coronary intervention for acute ST elevation myocardial infarction: Outcomes and determinants of outcomes: A tertiary care center study from North India. Indian Heart Journal. 2017;69(3):294-8.