A comparison of rescue and primary percutaneous coronary interventions for acute ST elevation myocardial infarction

Rahuman, M. B. F.; Jayawardena, Jayanthimala; Francis, George; Niraj, Mahboob; A.H.T., Wasantha Kumara; Wijesinghe, Aruna; Ariyapperuma, R; Paramanayakam, A.; Silva, Pubudu De

doi:10.1016/j.ihj.2017.02.019

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…In order to minimize such delays in coronary reperfusion a pharmaco-invasive strategy is suggested. A prompt pharmaco-invasive technique compared favourably with primary PCI in terms of reducing morbidity and death in STEMI patients, according to numerous research from close by nations 21,22,23 .…”

Section: Stemi Care -Structurementioning

confidence: 99%

STEMI Pakistan; A National Heart Attack Management Program.

Nishtar

2022

Pak. j. Cardio vas. int. (print/Online)

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Coronary artery disease (CAD) accounts for more than two-thirds of these deaths. It is indicated per the latest information that one in four Pakistani adults over 40 has CAD. The stable coronary disease has a relatively low annual mortality, while acute myocardial infarction (MI) carries a high mortality and morbidity. Though recent advancements in coronary interventions have however revolutionized the management of acute myocardial infarction, resulting in a significant reduction of cardiovascular morbidity and mortality in the developed world but in Pakistan, the majority of ST-elevation myocardial infarction (STEMI) patients still remain sub-optimally managed. Urban areas are relatively better equipped, but this does not necessarily translate into universal access to quality and timely cardiac care. There is not only substantial variation in accessibility and practices amongst cardiac healthcare facilities between rural and urban areas but also amongst major city hospitals. Such variations clearly indicate an urgent need for a nationwide standardized STEMI management program to ensure that everyone with an acute STEMI will have speedy access to quality and standard acute care without being economically burdened.

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Section: Stemi Care -Structurementioning

confidence: 99%

STEMI Pakistan; A National Heart Attack Management Program.

Nishtar

2022

Pak. j. Cardio vas. int. (print/Online)

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“…On the other hand, Rahuman et al [25], from the cardiology PCI Clinic of the National Hospital of Sri Lanka (NHSL), included all acute SEMI patients from March 2013 to April 2015 who were presenting with <24 h door-to-balloon time for primary PCI and <72 h door-to-balloon time, 90 min after failed thrombolysis for rescue PCI, and their in-hospital results were analyzed, comparing rescue and primary PCI patients. They concluded that major adverse cardiac events in hospital are similar in both primary and rescue intervention groups, supporting the rescue as an option for patients with no immediate access to PCI facilities.…”

Section: Regardingmentioning

confidence: 99%

Myocardial Perfusion Grade by Coronary Angiography can Predict Final Infarct Size and Left Ventricular Function in Patients with ST-elevation Myocardial Infarction Treated with a Pharmaco-invasive Strategy

Ahmed

Elhadidy

Helmy

et al. 2021

Open Access Maced J Med Sci

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BACKGROUND: Primary percutaneous coronary intervention (PCI) is the reperfusion strategy of choice in ST-elevation myocardial infarction (STEMI). Transfer for early angioplasty after thrombolytic therapy should be done without delay and has been directly related to improved patients’ outcome compared with thrombolysis alone. TIMI myocardial perfusion (TMP) grade provides important prognostic information for epicardial flow. AIM: We studied the relationship between TMP grade (at the end of the PCI procedure) and left ventricular ejection fraction (LVEF) and infarct size within 1 month in such patients. METHODS: A total of forty patients with diagnosis of STEMI (mean age 57.32 ± 10.44, 33 men) were studied, all patients underwent primary PCI. Grading of myocardial perfusion was done immediately post-PCI. Infarction size, end-diastolic volume (EDV), end-systolic volume (ESV), and LVEF were all measured by myocardial perfusion imaging (Gated single-photon emission computed tomography) within 1 month of STEMI. RESULTS: Final infarct size ranged from 0 to 59 cm (mean =19.18 ± 15.8 cm). EDV ranged from 52 to 228 ml (mean = 128.60 ± 51.01 ml). ESV ranged from 16 to 169 ml (mean =72.05 ± 42.09 ml) and EF ranged from 21% to 72% (mean = 46.0 ± 12.80%). Viable but ischemic myocardial area ranged from 0 to 18 cm (mean =3.38 ± 4.45 cm). There was a significant “negative” correlation between the myocardial perfusion grade and the final infarct size. Furthermore, myocardial perfusion grade was significantly inversely related to EDV and ESV, but directly related to EF. Patients who received thrombolytic therapy had significant lesser perfusion grade than who underwent PCI directly. CONCLUSION: Assessment of the myocardial perfusion grade during PCI is a good prognostic marker about the final infarct size, ESV, EDV, and EF in patients with STEMI treated with a pharmaco-invasive strategy (thrombolytic followed by PCI).

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Clinical Characteristics, Procedural Details, and Outcomes of Patients Who Underwent Percutaneous Coronary Intervention in Real-world Practice at a Tertiary Care Center in Sri Lanka

Rahuman,

Fernando,

Kempitiya

et al. 2023

Journal of Indian College of Cardiology

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Introduction: Outcomes of percutaneous coronary intervention (PCI) vary across different regions of the world. Despite a substantial increase in the demand for PCI in recent years, there is a lack of comprehensive data on PCI in Sri Lanka. Objective: The objective of this study was to investigate the pattern of PCI procedures in real-world practice in Sri Lanka over a period of time. Methods: This prospective descriptive study included all patients who underwent PCI at one unit of a tertiary care cardiac center in Colombo, Sri Lanka, between March 2022 and December 2022. Patients’ baseline clinical characteristics, procedural details, equipment usage, and complications were analyzed and followed up for 6 months. Results: Among 317 patients included in the analysis, 89.9% were ≥40 years old, with a mean age of 54.7 years (standard deviation: 11), and 73.5% were male. The most common presentation was chronic coronary syndrome, 65.9%, with 6.9% chronic total occlusion (CTO) cases. Within acute coronary syndrome cases, the highest percentage (27.1%) was attributed to ST-elevation myocardial infarction (MI), with 18.3% being anterior MI, suggesting that the left anterior descending artery was most commonly affected. Approximately 86.1% had single-vessel PCI, whereas 2.8% underwent left main PCI. Transradial access was obtained in 87.4%. Despite a 6.9% CTO, a high procedural success rate of 94.3% was observed. The inhospital mortality rate was low at 0.3%, and the 6-month mortality rate was 0.9%. Conclusions: Despite the limited sample size, our study provides valuable insights into the current practices and outcomes of PCI in Sri Lanka. Despite the constraints of limited resources, we observed a high success rate and minimal complications.

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A comparison of rescue and primary percutaneous coronary interventions for acute ST elevation myocardial infarction

Abstract: In-hospital major adverse cardiac events (MACE) are similar in both rescue and primary intervention groups, supporting the former as a practical option for patients with no immediate access to PCI facilities.

Cited by 3 publications

References 33 publications

STEMI Pakistan; A National Heart Attack Management Program.

STEMI Pakistan; A National Heart Attack Management Program.

Myocardial Perfusion Grade by Coronary Angiography can Predict Final Infarct Size and Left Ventricular Function in Patients with ST-elevation Myocardial Infarction Treated with a Pharmaco-invasive Strategy

Clinical Characteristics, Procedural Details, and Outcomes of Patients Who Underwent Percutaneous Coronary Intervention in Real-world Practice at a Tertiary Care Center in Sri Lanka

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