The Burden of Short-term Major Adverse Cardiac Events and its Determinants after Emergency Percutaneous Coronary Revascularization: A Prospective Follow-up Study

Abstract

Objectives Primary percutaneous coronary intervention (PCI) remains recommended reperfusion therapy for patients with acute ST-elevation myocardial infarction. This study aimed to evaluate the short-term major adverse cardiac events (MACE) and their determinants among patients who underwent primary PCI at a tertiary care cardiac center of Karachi, Pakistan. Methods A cohort of patients who underwent primary PCI were followed for the MACE. Multivariable Cox-regression analysis was performed with backward conditional variable selection and hazard ratio (HR) along with 95% confidence interval (CI) were obtained. Results A total of 1150 patients were included, of which follow-up was successful in 95.8% (1102) and median follow-up duration was 6.1 [6.9–5.1] months. MACE were observed in 210 (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 heart failure, 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]). Conclusions A significant number of individuals undergone primary PCI are still vulnerable to subsequent short-term MACE, hence, systematic follow-up and early risk stratification should be considered as an integral part of STEMI management protocol specially for patients with high-risk features as highlighted herein.

Fibrinogen and Intracoronary Thrombus as Predictors of Major Adverse Cardiovascular Events In-Hospital in St-Elevation Myocardial Infarction (STEMI) Patients Undergoing Primary Percutaneous Coronary Intervention

“…This finding is reinforced by previous studies, such as the study of Kumar et al which showed an association between thrombus grade and MACE (p<0.001) [27]. Multivariate analysis showed that large intracoronary thrombus as an independent predictor of MACE (adjusted HR 2.2; 95% CI In this study, the risk of MACE in patients with high fibrinogen with large intracoronary thrombus was 81%.…”

Association between NT-proBNP level and the number of stents with major advanced cardiovascular events (MACE) in patients with multivessel coronary artery disease treated with percutaneous coronary intervention: A prospective cohort study

“…This could be because of the limited post-PCI observation, given that the large studies like COMPLETE and CvLPRIT assessed MACE outcomes after at least one year [26]. Meanwhile, other studies reported that MACE was observed in subjects who received multiple stents and exhibited a more than a threefold increase in NT-proBNP levels [28][29][30].…”

Role of Systolic Blood Pressure to Left Ventricular End-Diastolic Pressure Ratio in Prediction of Major Adverse Cardiovascular Events in Patients with ST-segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

“…However, our study is in contrast with Zhang et al [11] who studied if central arterial pressure predicts in-hospital MACEs after acute STEMI and revealed that MACEs occurred in 22.6% of patients. Also, Kumar et al [12] who studied the burden of short-term MACEs and its determinants after emergency PCI where MACEs were observed in 210 (19.1%) patients. This can be explained by larger sample size in these studies (512 and 1150 patients respectively vs. 100 patients in our study).…”