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Tona WM, Tamiru MT, Beyene DA, Tegegne GT, Alemkere G, Shashu BA, Tadesse TA. Clinical outcomes and associated factors in patients who underwent percutaneous coronary intervention: a multicenter study in Ethiopia. Acta Cardiol 2024; 79:536-544. [PMID: 38884451 DOI: 10.1080/00015385.2024.2365607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/25/2024] [Accepted: 06/02/2024] [Indexed: 06/18/2024]
Abstract
AIMS This study aimed to evaluate the clinical outcomes and associated factors in patients who underwent percutaneous coronary intervention (PCI). METHODS This five-year retrospective cross-sectional study analyzed data from 241 patients who underwent urgent and primary PCI. Outcome measures included in-hospital mortality, major adverse cardiac and cerebrovascular events (MACCEs), postprocedural complications, and survival rates. Data were analysed using the Statistical Package for Social Sciences version 25. Cox proportional hazard regression models were used to assess predictors of in-hospital mortality. Kaplan-Meier analysis and the log-rank test were used to assess the overall survival rates and median survival time and to compare the survival probability curves for independent predictors. Hazard ratios (HRs) and 95% confidence intervals (CIs) were presented. RESULTS One hundred forty-two patients underwent elective PCI with drug-eluting stent implantation (75.1%) as the reperfusion method. The in-hospital mortality and non-fatal MACCE rates were 3.7% and 24.1%, respectively. The predictors of in-hospital mortality were female sex (AHR = 8.39, 95% CI: 1.20-58.68, p = 0.03), preprocedural obesity (AHR = 6.54, 95% CI: 1.10-40.60, p = 0.04), previous myocardial infarction (AHR = 9.68, 95% CI: 1.66-56.31, p = 0.01), chronic heart failure (AHR = 9.21, 95% CI: 1.38-61.78, p = 0.02), and a previous history of stroke (AHR = 18.99, 95% CI: 1.59-227.58, p = 0.02). Notably, this study reported a high one-year survival rate. CONCLUSION Urgent and primary PCIs are critical interventions for patients with MI in Ethiopia, showing promising outcomes such as low in-hospital mortality and a high one-year survival rate. These findings underscore the importance of optimising access to PCI and related treatments to improve patient outcomes.
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Affiliation(s)
- Wondimu Melesse Tona
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Pharmacy, College of Health and Medical Science, Hawassa University, Hawassa, Ethiopia
| | - Melaku Tileku Tamiru
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dessale Abate Beyene
- Department of Pharmacy, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Gobezie Temsegen Tegegne
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getachew Alemkere
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bekele Alemayehu Shashu
- Department of Internal Medicine, School of Medicine, College of Health and Medical Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Assefa Tadesse
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Hegazy MA, Mansour KS, Alzyat AM, Hegazy AA, Mohammad MA. Evaluation of Nonculprit Coronary Artery Lesions in Patients with Acute ST-Segment Elevation Myocardial Infarction. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2024; 17:367-377. [DOI: 10.4103/mjdrdypu.mjdrdypu_728_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2024] Open
Abstract
ABSTRACT
Background:
Multivessel coronary artery disease is a common finding during the primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction (STEMI). It might be a cause for recurrent attacks. This study aimed to evaluate nonculprit lesions (NCLs) encountered in the three major epicardial coronary arteries.
Methods:
Patients with STEMI who underwent PPCI and matched the study inclusion criteria were enrolled. They were evaluated clinically, biomedically, and coronary angiographically. The coronary angiography analysis was examined by four cardiologists using the Quantitative Coronary Artery Analysis software. The data was analyzed statistically.
Results:
Of the 154 patients included in the study, 130 (84.4%) were males and 24 (15.6%) were females, with a mean age of 52.92 ± 13.14 years. Five hundred seventy-four NCLs were found in 132 (85.7%) patients. Nonobstructive lesions with stenosis less than 70% of vessel diameter were more frequent than obstructive lesions. The left circumflex coronary artery (LCX) was the first one of the three major arteries to be affected by obstructive NCLs. The obstructive NCLs were 128 in number; found in 78 (50.4%) patients; 65 (50.8%) of them were in LCX; 32 (25%) were in left anterior descending (25%); and 31 (24.2%) were in right coronary artery.
Conclusions:
NCLs are common among STEMI patients. LCX obstructive NCLs are comparable to those in the other two major epicardial coronary arteries, with respect to frequency and severity of luminal stenosis.
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Affiliation(s)
- Mustafa A. Hegazy
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Kamal S. Mansour
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Ahmed M. Alzyat
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Abdelmonem A. Hegazy
- Human Anatomy and Embryology Department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
- Medical Lab Department, Faculty of Allied Medical Sciences, Zarqa University, Zarqa City, Jordan
| | - Mohammad A. Mohammad
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
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AL-Maimoony T, AL-Sageer N, Alnajjar M, Ali Kaid MG, Rajeh M, Al-Motarreb AL. Clinical Characteristics and Outcome of Percutaneous Coronary Intervention in Yemeni Patients. Heart Views 2023; 24:93-97. [PMID: 37305329 PMCID: PMC10249639 DOI: 10.4103/heartviews.heartviews_98_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/16/2023] [Indexed: 06/13/2023] Open
Abstract
Background Percutaneous coronary intervention (PCI) is increasingly used in the management of acute coronary syndromes (ACSs). PCI has decreased the demand for coronary artery bypass grafting, and more patients with ACS are now undergoing PCI. No previous data about the characteristics and outcome of patients performing PCI in Yemen. This study aimed to assess the patient presentation, characteristics, and outcome among Yemeni patients having PCI in the Military Cardiac Center. Methods All patients who underwent PCI either primary or elective in the Military Cardiac Center in Sanaa City were included over 6 months. Clinical, demographic, procedural, and outcome data were extracted and analyzed. Results During the study period, 250 patients underwent PCI. The mean ± standard deviation age was 57 ± 11 years, with 84% being male. Of all the patients, 61.6% (156) smoked tobacco, 56% (140) had hypertension, 37% (93) had Type 2 diabetes, 48.4% (121) had hyperlipidemia, and 8% (20) had a family history of ischemic heart disease. Coronary artery presentation was in the form of acute ST-elevation myocardial infarction at 41% (102), non-STEMI at 5.2% (58), stable angina at 31% (77), and unstable angina at 5.2% (13). Coronary artery interventions were elective PCI in 81% (203), emergency in 11% (27), and urgent in 8% (20) with only 3% radial artery access and 97% femoral access. PCI was mainly in the left anterior descending artery in 82% (179), right coronary artery in 41% (89), left circumflex artery in 23% (54), and left main in 1.25% (3). All stents were drug-eluting stents during the registry time. Complication occurred in 17.6% (44) and case fatality was 2% (5). Conclusions Despite the current situation in Yemen, PCI was performed with success in a large number of patients with a low incidence of inhospital complications and mortality that is comparable to high- or middle-income settings.
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Affiliation(s)
- Taha AL-Maimoony
- Department of Cardiology, Faculty of Medicine, Sanaa University, Sanaa, Yemen
| | - Nora AL-Sageer
- Department of Cardiology, Faculty of Medicine, Sanaa University, Sanaa, Yemen
| | - Mervat Alnajjar
- Department of Cardiology, Faculty of Medicine, Sanaa University, Sanaa, Yemen
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Aly K, Sabet S, Elkiey A, Fakhry H. The Complexity of Peripheral Arterial Disease and Coronary Artery Disease in Diabetic Patients: An Observational Study. Cardiol Res 2023; 14:54-62. [PMID: 36896224 PMCID: PMC9990548 DOI: 10.14740/cr1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/02/2023] [Indexed: 02/27/2023] Open
Abstract
Background Atherosclerosis is a systemic disease that causes luminal narrowing. Patients with peripheral arterial disease (PAD) also exhibit an increased risk of death from cardiovascular complications. This risk is the same for symptomatic or asymptomatic patients. Over a 5-year period, patients with PAD have a 20% chance of suffering from a stroke or myocardial infarction. Additionally, their mortality rate is 30%. This study aimed to assess the relationship between coronary artery disease (CAD) complexity using SYNTAX score and PAD complexity using Trans-Atlantic Inter-Society Consensus II (TASC II) score. Methods The study was designed as single-center cross-sectional observational and included 50 diabetic patients referred for elective coronary angiography and peripheral angiography was done. Results Most of the patients were males (80%) and smokers (80%) with mean age of 62 years. The mean SYNTAX score was 19.88. There was a significant negative correlation between SYNTAX score and ankle brachial index (ABI) (r = -0.48, P = 0.001) and a significant positive correlation with glycated hemoglobin (HbA1c) level (R2 = 26, P = 0.004). Complex PAD was found in nearly half of the patients with 48% having TASC II C or D classes. Those with TASC II classes C and D had higher SYNTAX scores (P = 0.046). Conclusions Diabetic patients with more complex CAD had more complex PAD. In diabetic patients with CAD, those with worse glycemic control had higher SYNTAX scores and the higher the SYNTAX score, the lower the ABI.
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Affiliation(s)
- Khaled Aly
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sameh Sabet
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Alaa Elkiey
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hany Fakhry
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Kamal A, Zaki A, Abdelaaty A, Madkour M. Management of ST-segment elevation myocardial infarction in comparison to European society of cardiology guidelines in Alexandria University Hospitals, Egypt. Egypt Heart J 2023; 75:5. [PMID: 36680659 PMCID: PMC9867789 DOI: 10.1186/s43044-023-00332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND For patients with ST-elevation myocardial infarction (STEMI), early reperfusion with primary percutaneous coronary intervention (PPCI) or thrombolytic treatment is essential to prevent major adverse cardiac events. The aim of the study is to compare the current status of managing STEMI patients at **** with European Society of Cardiology guidelines recommendations. Prospective cohort of all patients presenting with ST-elevation myocardial infarction (STEMI) between March 2020 and February 2021 in Alexandria University hospitals. Reporting patterns, causes of delay, and reperfusion status for all STEMI patients were noted. MACE: (Mortality, Re-infarction, Stroke, or Heart failure) was reported and compared among different management strategies. RESULTS The study was conducted over one year on 436 patients, 280 (64.2%) of them underwent PPCI, 32 (7.3%) received thrombolysis, and 124 (28.5%) had a conservative strategy. Patients' mean age was 55.2 years, 72.2% were smokers and 80.9% were men. Family history was positive in 14.2% of patients, 33.5% had diabetes, 7.3% had renal impairment, and 41.5% had hypertension. The median pre-hospital waiting time was 360 min; the mean pre-hospital waiting time was 629.0 ± 796.7 min. The median Emergency Room waiting time was 48.24 ± 89.30 min. The median time from CCU admission to wire crossing was 40.0 min with a mean value 53.86 ± 49.0 min. The mean ischemia duration was 408 min, while the total ischemic time was 372 min. All patients who presented within 12 h received reperfusion therapy either a PPCI or thrombolysis at a rate of 71.5%, with 35.0% of those patients achieving prompt reperfusion in accordance with ESC guidelines. The PPCI group mortality rate was 2.9%, in comparison to 12.9% in the conservative group, which was statistically significant (P < 0.001). Overall in-hospital mortality was 5.5%, and total MACE was 27.3%. A statistically significant difference was observed between the three management groups as regards MACE rate, being 15%, 28.1%, and 54.8% in PPCI, thrombolysis, and conservative groups, respectively. CONCLUSIONS Despite financial and technical constraints, appropriate, timely reperfusion was near to achieving the ESC guidelines for the management of STEMI. The most common reperfusion strategy was PPCI, with an in-hospital death rate of less than 5% in the PPCI group. There was a concern about the increase in the total ischemia time due to some financial and technical constraints.
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Affiliation(s)
- Amr Kamal
- grid.7155.60000 0001 2260 6941Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria Egypt
| | - Amr Zaki
- grid.7155.60000 0001 2260 6941Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria Egypt
| | - Ahmed Abdelaaty
- grid.7155.60000 0001 2260 6941Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria Egypt
| | - Moustafa Madkour
- grid.7155.60000 0001 2260 6941Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria Egypt
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Adem F, Abdi S, Amare F, Mohammed MA. In-hospital mortality from acute coronary syndrome in Africa: a systematic review and meta-analysis. SAGE Open Med 2023; 11:20503121221143646. [PMID: 36685798 PMCID: PMC9850135 DOI: 10.1177/20503121221143646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/18/2022] [Indexed: 01/18/2023] Open
Abstract
Objective There is an increasing recognition of the burden of cardiovascular disease in Africa. However, little is known about the pooled prevalence of acute coronary syndrome (ACS)-associated in-hospital mortality and contributing factors. Methods PubMed, Medline, Embase, Web of Science (Core Collection), and supplementary sources including Google Scholar, World Cat, Research Gate, and Cochrane Library were searched. Chi-square test and I 2-statistic were used to assess heterogeneity. Egger's and Begg's tests and funnel plots were used to assess publication bias. Data were analyzed using Stata software (version 15.0). Result Twenty nine studies with a total sample of 11,788 were included. The pooled estimate of all-cause in-hospital mortality was 22% (pooled proportion (PP) = 0.22; 95% confidence interval (CI): 0.17-0.27. The In-hospital mortality rate was lower at the cardiac centers (PP = 0.14; CI: 0.05-0.23) compared to referral hospitals (PP = 0.24; CI: 0.17-0.31]) The mortality rate was comparable in Eastern (PP = 0.23; CI: 0.19-0.27) and Northern Africa (PP = 0.22; CI: 0.16-0.28). The incidence of in-hospital heart failure, cardiogenic shock, arrhythmia, bleeding, acute stroke, and reinfarction were 42, 17.0, 20.0, 16.0, 4.0, and 5.0%, respectively. Conclusion All-cause in-hospital mortality rate associated with ACS is high in Africa. The mortality rate at cardiac centers was 10% lower when compared with referral hospitals. Establishing coronary units, strengthening existing cardiac services, and improving availability and access to cardiovascular medicines could help in reducing the burden of ACS in the continent.
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Affiliation(s)
- Fuad Adem
- Department of Clinical Pharmacy,
College of Health and Medical Sciences, Haramaya University, Haramaya, Oromia,
Ethiopia,Fuad Adem, Haramaya University College of
Health and Medical Sciences, Harar, Haramaya, Oromia 238, Ethiopia.
| | - Semir Abdi
- Department of Internal Medicine,
College of Health and Medical Sciences, Haramaya University, Haramaya, Oromia,
Ethiopia
| | - Firehiwot Amare
- Department of Pharmacology and Clinical
Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mohammed A Mohammed
- Faculty of Medical and Health Sciences,
School of Pharmacy, The University of Auckland, Auckland, New Zealand
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Implementation of a Regional STEMI Network in North Cairo (Egypt): Impact on The Management and Outcome of STEMI Patients. Glob Heart 2023; 18:2. [PMID: 36760803 PMCID: PMC9881442 DOI: 10.5334/gh.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Background Regional ST-segment-elevation myocardial infarction (STEMI) networks facilitate timely performance of primary percutaneous coronary intervention (PPCI), reduce mortality and improve outcomes. Few data exist on the feasibility and impact of regional STEMI networks in developing countries. Aim of the Work The aim of this study was to examine the feasibility and impact of establishing a regional STEMI network on the management and outcomes of STEMI patients in north Cairo. Patients and Methods A prospective observational study conducted on 352 patients presenting in North Cairo with confirmed diagnosis of STEMI within 48 hours of symptoms. Patients were divided into group I (n = 140) before and group II (n = 212) after establishment of the STEMI network. Both groups were compared as regards patients' demographics, presentation, management and short-term outcomes. The north Cairo regional STEMI network was established among four governmental hospitals and the governmental ambulance was used for interhospital transfer. WhatsApp® was used for trans-network team communication. Results Mean age of the study population was 55.4 ± 11.02 years and 286 (81.3%) were males. Mean time from chest pain to first medical contact did not change between the two groups (240 minutes; P = 0.36) while door to balloon mean time was reduced (from 54.3 to 44.1 minutes: P = 0.01). Use of thrombolytic therapy declined from 51 (36.4%) to 16 (7.5%) (P < 0.001) while primary PCI increased from 59.8% to 77.1% (p < 0.001). Left ventricular ejection fraction improved from 51.3 ± 10.7 to 55.4 ± 9.1 (P < 0.001), the mean time of CCU stay was reduced from a mean of 3.0 to 2.0 days (P < 0.001) and in-hospital mortality improved from 6.4% to 2.8% (P = 0.10). Conclusion The establishment of the STEMI network in north Cairo was feasible and improved patients' outcomes. Use of primary PCI increased and in-hospital mortality improved from after establishment of STEMI network.
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Shaheen S, Helal A, Anan I. Barriers to the Implementation of Primary PCI in the Management of STEMI in Egypt. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2021. [DOI: 10.15212/cvia.2021.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Evidence-based guidelines recommend primary percutaneous coronary intervention (PPCI) be the mainstay reperfusion strategy for the treatment of ST-segment elevation myocardial infarction (STEMI) if it is performed in the proper time window. However, the Egyptian
health care system is still struggling to provide such an important service. The aim of the present study, through a quantitative questionnaire, is to explore the current practice of STEMI management in Egypt, and to identify the barriers, opportunities, and potential areas for improvement.Methods
and Results: The questionnaire was conducted in Egypt via face-to-face qualitative in-depth interviews with cardiologists from 14 PPCI-capable hospitals and 26 non-PPCI-capable hospitals. Participants were selected in view of their experience and knowledge. The study identified potential
barriers to the implementation of PPCI among STEMI patients in Egypt. These barriers included the prehospital patient delay and emergency medical service delay, delay in the emergency department and delay in patient transfer to the CCU, unavailable equipment, catheterization laboratory activation
delay, lack of trained interventional cardiologists, lack of regional STEMI networks and hospital policies, and insufficient ICU beds.Conclusion: Limited resources and health care system inadequacies have led to potential barriers that prevent suboptimal implementation of PPCI in
Egypt. Efforts from all health care providers should be directed to overcome these identified barriers.
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Affiliation(s)
- Sameh Shaheen
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ayman Helal
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Islam Anan
- Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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