Acute Coronary Syndromes (STEMI, NSTE-ACS)
The Burden of Short-term Major Adverse Cardiac Events and Its Determinants After Emergency Percutaneous Coronary Revascularization: A Prospective Follow-up Study
Rajesh Kumar1, Nadeem Qamar2, Tahir Saghir2, Jawaid Akbar Sial2, Naveedullah Khan2, Musa Karim2
National Institute of Cardiovascular Diseases, Pakistan1, National Institute of Cardiovascular Diseases (NICVD), Pakistan2
Primarypercutaneous coronary intervention (PCI) remains recommended reperfusiontherapy for patients with acute ST-elevation myocardial infarction. This studyaimed to evaluate the short-term major adverse cardiac events (MACE) and theirdeterminants among patients who underwent primary PCI at a tertiary carecardiac center of Karachi, Pakistan.
Acohort of patients who underwent primary PCI were followed for the MACE.Multivariable Cox-regression analysis was performed with backward conditionalvariable selection and hazard ratio (HR) along with 95% confidence interval(CI) were obtained.
Atotal of 1150 patients were included, of which follow-up was successful in95.8% (1102) and mean follow-up duration was 5.97±2.32 months. MACE wereobserved in 201 (19.1%) patients with 14.2% (157) all-cause mortality, 5.4% (60)cardiac mortality, 0.7% (8) stroke, 3.6% (40) re-hospitalization due to heartfailure, and 6.1% (67) myocardial infarction requiring revascularization.Independent predictors of short-term MACE were found to be admission glucose≥200 mg/dl (1.66 [1.25-2.21]), serum creatinine ≥1.5 mg/dl (1.52 [1.02-2.27]), intubation (2.81[1.98-4.00]), history of PCI (2.06 [1.45-2.93]), history of cerebrovascular accident (2.64 [1.34-5.2]), left ventricular end-diastolic pressure ≥20 mmHg (1.81 [1.3-2.51]), triple vessel diseases (1.43 [1.08-1.9]), culprit left main or proximal left anterior descending artery (1.77 [1.32-2.35]), pre-ballooning (2.14[1.2-3.82]), and thrombus grade≥4 (2.21 [1.51-3.24]).
Asignificant number of individuals undergone primary PCI are still vulnerable tosubsequent short-term MACE, hence, systematic follow-up and early riskstratification should be considered as an integral part of STEMI managementprotocol specially for patients with high-risk features as highlighted herein.