Outcome of patients with ST segment elevation myocardial infarction (STEMI) following percutaneous transluminal coronary angioplasty: a retrospective study.

V Abeysuriya,Vs Hettiarachchi,Ar Wickremasinghe,Lg Chandrasena,A Kasturiratne

doi:10.4038/cmj.v59i4.7862

Abstract

To study the characteristics and long term outcome of patients who had segment elevation myocardial infarction (STEMI) and treated with PTCA in a fee levying hospital in Sri Lanka. A retrospective study was conducted among patients diagnosed with STEMI and treated with PTCA in a fee levying private hospital in Colombo from 1st January 2009 to 1st November 2012. Details of patients were obtained from medical records and the survival status, cause of death and date of death where relevant, were obtained from records, patients or close relatives. 197 patients (153 men; 77.7%) were included. More than 50% had a history of diabetes, dyslipidaemia or hypertension. The three year survival was 82.7% (95% CI: 77.9%-90.5%). Based on the Cox's Proportional Hazards model, site of arterial occlusion (proximal vs distal segment of left anterior descending artery [LAD] was significantly associated with mortality due to all causes [HR 10.98; 95% CI: 1.09-110.20]. Low ejection fraction, not on regular medication and delay of more than 3 hours between onset to door time were associated with death due to cardiovascular causes in patients whose right coronary artery or left circumflex artery was the culprit artery. The three year survival of patients with STEMI and who had PTCA was 83%. Patients with proximal LAD occlusion were 11 times more likely to die within 3 years of PTCA as compared to those who had a distal LAD occlusion.

Highlights

Cardiovascular diseases remain a major cause of death worldwide
Acute coronary syndrome encompasses a spectrum of coronary artery diseases, including unstable angina, ST-elevation myocardial infarction (STEMI) and non ST-elevation myocardial infarction [2]
Exclusion criteria were patients who had unstable angina or LBBB and other cardiac problems such as cardiomyopathy and valvular heart diseases, patients who experienced out-of-hospital cardiac arrest, patients who failed to have a return of spontaneous circulation (ROSC), and patients who had the first ECG after cardiopulmonary resuscitation

Summary

Introduction

Over the last two decades, cardiovascular mortality rates have declined in many high-income countries. Cardiovascular deaths and disease incidence have increased at an alarmingly high rate in low-and middle-income countries [1]. Acute coronary syndrome encompasses a spectrum of coronary artery diseases, including unstable angina, ST-elevation myocardial infarction (STEMI) and non ST-elevation myocardial infarction [2]. The most severe form of acute coronary syndrome (ACS) is STEMI [3]. The demographics in Sri Lanka are changing to an older and ageing population. The country has to deal with escalating health care costs as a result of increasing rates of non-communicable diseases (NCDs). NCDs accounts for 85% of ill health, disability and early deaths in Sri Lanka [4]

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