OUTCOME OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION

Abstract

Background: A sudden onset ST-segment elevation myocardial infarction is a life-threatening presentation of coronary artery disease which requires prompt restoration of coronary blood flow. In cases where reperfusion is performed promptly, primary PCI is the preferred option. This study evaluated the outcomes of primary PCI for acute STEMI.

Methods: It was a cross sectional study in the Cardiology Department of Said Sharif Medical College and Teaching Hospital over a period of six months. Fifteen-nine patients aged between 18 and 75 were recruited using consecutive non-probability sampling method. Procedural success was considered when a residual coronary stenosis of 30% or less and final Thrombolysis in Myocardial Infarction grade III distal flow was achieved. A structured proforma was used to gather demographic, clinical and socioeconomic data. IBM SPSS Statistics version 21 was used for data analysis. Frequencies, percentages, means, standard deviations, medians and interquartile ranges were calculated. Chi square test or Fisher's exact test was used to assess association with outcome.

Results: The success rate of primary PCI was 96.2% (153/159), with six patients failing to have a successful procedure. Increased duration of illness for more than six hours, diabetes mellitus, post-infarction heart failure and cardiogenic shock were significantly associated with unsuccessful PCI. The greatest association with procedural failure was for cardiogenic shock. There were no significant associations with age, sex, BMI, hypertension, smoking history, or socioeconomic status, residence, education or occupation.

Conclusions: The rate of successful primary PCI was very high. Further improvement in reperfusion outcome in regional tertiary cardiac care systems may be achieved by reducing delay in treatment and prioritizing patients with diabetes, heart failure and cardiogenic shock.