Kumar Rajesh, Shah Jehangir A, Solangi Bashir A, Ammar Ali, Kumar Mukesh, Khan Naveedullah, Sial Jawaid A, Saghir Tahir, Qamar Nadeem, Karim Musa
National Institute of Cardiovascular Diseases, Karachi, Pakistan.
J Saudi Heart Assoc. 2022 Jun 11;34(2):100-109. doi: 10.37616/2212-5043.1302. eCollection 2022.
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.
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.
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]).
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.
对于急性ST段抬高型心肌梗死患者，直接经皮冠状动脉介入治疗（PCI）仍是推荐的再灌注治疗方法。本研究旨在评估在巴基斯坦卡拉奇一家三级心脏护理中心接受直接PCI治疗的患者的短期主要不良心脏事件（MACE）及其决定因素。
对一组接受直接PCI治疗的患者进行MACE随访。采用向后条件变量选择进行多变量Cox回归分析，并获得风险比（HR）及95%置信区间（CI）。
共纳入1150例患者，其中95.8%（1102例）随访成功，中位随访时间为6.1[6.9 - 5.1]个月。210例（19.1%）患者发生MACE，其中全因死亡率为14.2%（157例），心源性死亡率为5.4%（60例），卒中发生率为0.7%（8例），因心力衰竭再次住院率为3.6%（40例），需要血管重建的心肌梗死发生率为6.1%（67例）。发现短期MACE的独立预测因素为入院血糖≥200mg/dL（1.66[1.25 - 2.21]）、血清肌酐≥1.5mg/dL（1.52[1.02 - 2.27]）、插管（2.81[1.98 - 4.00]）、PCI病史（2.06[1.45 - 2.93]）、脑血管意外病史（2.64[1.34 - 5.2]）、左心室舒张末期压力≥20mmHg（1.81[1.3 - 2.51]）、三支血管病变（1.43[1.08 - 1.9]）、罪犯血管为左主干或左前降支近端（1.77[1.32 - 2.35]）、球囊预扩张（2.14[1.2 - 3.82]）以及血栓分级≥4（2.21[1.51 - 3.24]）。
相当数量接受直接PCI治疗的患者仍易发生随后的短期MACE，因此，系统的随访和早期风险分层应被视为ST段抬高型心肌梗死管理方案的一个组成部分，特别是对于本文所强调的具有高危特征的患者。
