65. Impact of focused echocardiography in clinical decision of patients presented with STMI, underwent primary percutenouse angioplasty

Abstract

Echocardiography in coronary artery diseases is an essential, routine echocardiography prior to primary percutaneous angioplasty is not clear. In our clinical practice in primary angioplasty we faced lots of complications either before or during or after the procedure. Moreover, lots of incidental findings that discovered after the procedure which if known will affect the plan of management. One-hundred-nineteen consecutive underwent primary angioplasty. All patients underwent FE prior to the procedure in catheterization lab while the patient was preparing for the procedure. FE with 2DE of LV at base, mid and apex, and apical stander views. Diastology grading, E/E′ and color doppler of mitral and aortic valve were performed. (N = 119) case of STMI were enrolled, mean age 51 ± 12 year. Eleven cases (9.2%) had normal coronary and normal LV function. Twenty cases (17%) of MI complication detected before the procedures: RV infarction 8.4% (5.1% asymptomatic and 3.3% symptomatic), ischemic MR (8.4%), LV apical aneurysm (0.8%), significant pericardial effusion (0.80%). Acute pulmonary edema in 17 cases (14.3%): six cases (5.1%) developed acute pulmonary edema on the cath lab with grade 3 diastolic dysfunction and E/E ′ >20, 9 cases (7.6%) develop acute pulmonary edema in CCU with grade 2–3 diastolic dysfunction and E/E′ 15–20. 2 cases (2.7%) develop acute pulmonary in CCU with grade 1–2 diastolic dysfunction and E/E′ 9–14. One case (0.8%) presented cardiac tamponade 2 h post PCI. Incidental finding not related to STMI were as follow: 2 cases (1.7%) with severe fibro degenerative MR, 2 cases (1.7%) with mild to moderate AR and 2 cases (1.7%) with mild to moderate AS. Isoled CABG 5/4.2% and CABG and MVR 2/1.7%. FE play an important role in guiding the management, early detection the incidental findings and complication post PCI.