Experience and Outcomes of Primary Percutaneous Coronary Intervention for Patients with ST-Segment Elevation Myocardial Infarction of Tertiary Care Center in Bosnia and Herzegovina

Clinical outcomes and associated factors in patients who underwent percutaneous coronary intervention: a multicenter study in Ethiopia

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.

Impact of primary percutaneous coronary intervention on ST-segment elevation myocardial infarction patients: A comprehensive analysis

BACKGROUND

Myocardial infarction, particularly ST-segment elevation myocardial infarction (STEMI), is a key global mortality cause. Our study investigated predictors of mortality in 96 STEMI patients undergoing primary percutaneous coronary intervention at Erbil Cardiac Center. Multiple factors were identified influencing in-hospital mortality. Significantly, time from symptom onset to hospital arrival emerged as a decisive factor. Consequently, our study hypothesis is: "Reducing time from symptom onset to hospital arrival significantly improves STEMI prognosis."

AIM

To determine the key factors influencing mortality rates in STEMI patients.

METHODS

We studied 96 consecutive STEMI patients undergoing primary percutaneous coronary intervention (PPCI) at the Erbil Cardiac Center. Their clinical histories were compiled, and coronary evaluations were performed via angiography on admission. Data included comorbid conditions, onset of cardiogenic shock, complications during PPCI, and more. Post-discharge, one-month follow-up assessments were completed. Statistical significance was set at P < 0.05.

RESULTS

Our results unearthed several significant findings. The in-hospital and 30-d mortality rates among the 96 STEMI patients were 11.2% and 2.3% respectively. On the investigation of independent predictors of in-hospital mortality, we identified atypical presentation, onset of cardiogenic shock, presence of chronic kidney disease, Thrombolysis In Myocardial Infarction grades 0/1/2, triple vessel disease, ventricular tachycardia/ventricular fibrillation, coronary dissection, and the no-reflow phenomenon. Specifically, the recorded average time from symptom onset to hospital arrival amongst patients who did not survive was significantly longer (6.92 ± 3.86 h) compared to those who survived (3.61 ± 1.67 h), P < 0.001. These findings underscore the critical role of timely intervention in improving the survival outcomes of STEMI patients.

CONCLUSION

Our results affirm that early hospital arrival after symptom onset significantly improves survival rates in STEMI patients, highlighting the critical need for prompt intervention.

Experience and Outcomes of Primary Percutaneous Coronary Intervention in a Tertiary Care Hospital in South Punjab, Pakistan

BACKGROUND

Primary percutaneous coronary intervention (PCI) is the emergency procedure and gold standard for the treatment of ST-Elevation Myocardial Infarction (STEMI).

OBJECTIVE

To share the experience and outcomes of primary PCI in a tertiary care hospital in South Punjab, Pakistan.

METHODS

A descriptive cross-sectional study was planned from the 1st of April, 2023 to the 30th of September, 2023. All patients presenting with acute STEMI undergoing primary PCI were included in the study. Data regarding patient demographics, risk factors, procedural characteristics, time variables, and in-hospital events was observed.

RESULTS

A total of 1132 patients were included in the study. There were 934 (82.5%) males. Smoking is the most common risk factor among all the patients. Anterior wall myocardial infarction is the most common STEMI and the left anterior descending artery is the culprit vessel in 58.3% (n=660) of patients. Single vessel disease was present in 34.6% (n=392) of the patients. Thrombolysis in Myocardial Infarction (TIMI )Flow III was achieved in 80% (n=906) of patients after primary PCI. The average total ischemic time of the patients included in the study was 5 hours and 48 minutes, with a standard deviation of 3 hours and 55 minutes. Our mortality was 3.5% (n=40).

CONCLUSION

Our patients take a longer time to present to the PCI-capable centers. Despite their late presentation, primary PCI has better outcomes for treating acute STEMI.

Association of collateral flow with clinical outcomes in patients with acute myocardial infarction

Coronary collateral flow is an important prognostic marker in percutaneous coronary intervention (PCI) for chronic total occlusion. However, the role of collateral flow to the culprit lesion of acute myocardial infarction (AMI) has not been fully established yet. The purpose of this retrospective study was to examine the association between collateral flow and long-term clinical outcomes in patients with AMI. We included 937 patients with AMI, and divided those into the no-collateral group (n = 704) and the collateral group (n = 233) according to the presence or absence of collateral flow to the culprit lesion of AMI. The primary endpoint was the incidence of major adverse cardiac events (MACE), which was defined as a composite of all-cause death, non-fatal MI, re-admission for heart failure, and ischemia driven target vessel revascularization. The median follow-up duration was 473 days (Q1: 184 days- Q3: 1027 days), and a total of 263 MACE was observed during the study period. The incidence of MACE was significantly greater in the no-collateral group than in the collateral group (29.8% vs. 22.3%, p = 0.027). In the multivariate COX hazard model, the presence of collateral flow was inversely associated with MACE (HR 0.636, 95% CI 0.461-0.878, p = 0.006) after controlling multiple confounding factors. In conclusion, the presence of collateral flow to the culprit lesion of AMI was inversely associated with long-term adverse outcomes. Careful observation of collateral flow may be important in emergent coronary angiography to stratify a high-risk group among various patients with AMI.

Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review

BACKGROUND

While the evidence for the clinical effectiveness of most noncommunicable disease (NCD) prevention and treatment interventions is well established, care delivery models and means of scaling these up in a variety of resource-constrained health systems are not. The objective of this review was to synthesize evidence on the current state of implementation research on priority NCD prevention and control interventions provided by health systems in low- and middle-income countries (LMICs).

METHODS AND FINDINGS

On January 20, 2021, we searched MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the World Health Organization (WHO) priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Given the focus on this review and the heterogeneity in aims and methodologies of included studies, risk of bias assessment to understand how effect size may have been compromised by bias is not applicable. We instead commented on the distribution of research designs and discussed about stronger/weaker designs. We synthesized extracted data using descriptive statistics and following the review protocol registered in PROSPERO (CRD42021252969). Of 9,683 potential studies and 7,419 unique records screened for inclusion, 222 eligible studies evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries). The number of studies published has been increasing over time. Nearly 40% of all the studies were on cervical cancer. With regards to intervention type, screening accounted for 49%, treatment for 39%, while prevention for 12% (with 80% of the latter focusing on prevention of the NCD behavior risk factors). Feasibility (38%) was the most studied implementation outcome followed by adoption (23%); few studies addressed sustainability. The implementation strategies were not specified well enough. Most studies used quantitative methods (86%). The weakest study design, preexperimental, and the strongest study design, experimental, were respectively employed in 25% and 24% of included studies. Approximately 72% of studies reported funding, with international funding being the predominant source. The majority of studies were proof of concept or pilot (88%) and targeted the micro level of health system (79%). Less than 5% of studies report using implementation research framework.

CONCLUSIONS

Despite growth in implementation research on NCDs in LMICs, we found major gaps in the science. Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.

Clinical-epidemiological aspects of patients submitted to Percutaneous Coronary Intervention in a university hospital

OBJECTIVE

To outline the clinical-epidemiological profile of patients submitted to Percutaneous Coronary Intervention in a Reference Hospital in Urgent Cardiology Clinic of the state of Rio Grande do Norte.

METHOD

This is a descriptive, exploratory, prospective study with a quantitative approach developed in a Brazilian University Hospital with patients submitted to Percutaneous Coronary Intervention. Data collection occurred between April and October 2017.

RESULTS

The sample consisted of 222 patients, of whom 58.10% underwent Elective Percutaneous Coronary Intervention and 41.89% were primary, 65.3% males, with a mean age of 62.7. In comorbidities "Hypertension", "Acute Myocardial Infarction", "Current Smoking" and "Physical Inactivity" were highlighted.

CONCLUSION

In the elective patients, there was a high prevalence of risk factors and in patients with urgent cases, high time of total ischemia. It is necessary to create strategies to structure the care line, to improve the effectiveness of treatment and to minimize adverse outcomes.

Acute care for the three leading causes of mortality in lower-middle-income countries: A systematic review

According to the World Health Organization, the three leading causes of mortality in lower-middle-income countries (LMIC) are ischemic heart disease (IHD), stroke, and lower respiratory infections (LRIs), causing 111.8, 68.8, and 51.5 annual deaths per 100,000, respectively. Due to barriers to healthcare, patients frequently present in critical stages of these diseases. Measured implementations in critical care in LMIC have been published; however, the literature has not been formally reviewed. We performed a systematic review of the literature indexed in PubMed as of October 2017. Abstracts were limited to human studies in English, French, and Spanish, conducted in LMIC, and containing quantitative data on acute care of IHD, stroke, and LRI. The search resulted in 4994 unique abstracts. Through multiple rounds of screening using criteria determined a priori, 161 manuscripts were identified: 38 for IHD, 20 for stroke, 26 for adult LRI, and 78 for pediatric LRI. These studies, predominantly from Asia, demonstrate successful diagnostic and treatment measures used in providing acute care for patients in LMIC. Given that, only four manuscripts originated in Central or South America, original research from these areas is lacking. IHD, stroke, and LRIs are significant causes of mortality, especially in LMIC. Diagnostic and therapeutic interventions for IHD (monitoring, medications, thrombolytics, percutaneous intervention, coronary artery bypass graft), stroke (therapeutic hypothermia, medications, and thrombolytics), and LRI (oxygen saturation measurement, diagnostic ultrasound, administration of oxygen, appropriate antibiotics, and other medications) have been studied in LMIC and published.