Patients In Primary Percutaneous Coronary Intervention Group Research Articles

Evaluation of Tpeak to end/QT and Tpeak to end/QTc ratios in patients with STEMI undergoing percutaneous intervention vs. thrombolytic therapy

IntroductionThe patients with ST-segment Elevation Myocardial Infarction (STEMI) are significantly at increased risk of arrhythmia. Repolarization of myocardium has been evaluated by a series of electrical parameters including T wave peak to T wave end (Tp-Te) and Tp-Te/QT ratio. Which were compared with survival outcomes between two groups of STEMI patients treated with Primary Percutaneous Coronary Intervention (PPCI) and recombinant Tissue Plasminogen Activator (r-TPA). MethodsIn this prospective study, 188 patients with STEMI were included in the study. 12‑Lead ECGs were obtained from all patients on time of admission and after 24 h after treatment. After dividing the patients into two groups based on their type of treatment (PPCI or r-TPA), The Tp-Te/QT and Tp-Te/QTc ratios were calculated using ECG records. The survival outcomes were compared between two groups. Results95 patients (50.5%) underwent PPCI and 93 patients (49.5%) received r-TPA. Tp-Te/QT and Tp-Te/QTc ratios after administration of the treatments were significantly decreased in both groups (P-value = .001) with lower Tp-Te/QT and Tp-Te/QTc ratios in PPCI group (P-value = .001). 7 patients in PPCI group (7.3%) and 16 patients in r-TPA group (17.2%) were died during their hospitalization period (P-value = .04). The best combination of sensitivity and specificity of post treatment Tp-Te/QT ratio was at cutoff points of 29.4 with 82% sensitivity and 83% specificity. ConclusionOur study demonstrated that Tp-Te/QT and Tp-Te/QTc ratios decrease significantly after both PPCI and r-TPA therapies, but with PPCI these indexes decrease more than r-TPA, resulting a better survival outcome in patients with STEMI.

Short-term Cost-effectiveness of Reteplase versus Primary Percutaneous Coronary Intervention in Patients with Acute STEMI a Tertiary Hospital in Iran

Introduction: This study aimed to compare primary percutaneous coronary intervention (PPCI) versus reteplase in terms of clinical and para-clinical outcomes; as well as cost-effectiveness in patients with ST-segment-elevation myocardial infarction (STEMI).Primary percutaneous coronary intervention is the method of choice in all patients especially those at higher risks. But an on-site professional team in a 24/7 facilitated system is a difficult goal to achieve in many areas and countries, therefore the cost-effectiveness of these two treatment strategies (PPCI and reteplase) needs to be discussed. Methods: This prospective cohort study included 220 patients presented with STEMI who were admitted to a university hospital between January 2014 to July 2016. Patients were divided into two groups of 120, either receiving reteplase or PPCI. Clinical outcomes were considered duration of hospital stay and MACE (Major Advanced Cardiovascular Events) including death, cerebrovascular accident, need for repeat revascularization, and major bleeding. LVEF (Left ventricular ejection fraction) was considered as a para-clinical outcome. The outcomes and total hospital cost were compared between two treatment groups. Results: Demographic characteristics between two groups of PPCI or reteplase didn’t show any significant differences. But in para-clinical outcomes, patients in PPCI group showed higher LVEF, compared with reteplase group (45.9 ± 11.5% versus 42.0 ± 11.8%; P = 0.02). Complication rates were similar in both groups but repeat revascularization or coronary artery bypass surgery was more prevalent in those who received thrombolytic therapy (P < 0.05). Length of hospital stay in both groups was similar in two groups but total cost was higher in patients who have received PPCI. (147769406.9 ± 103929358.9 Tomans vs. 117116656.9 ± 67356122.6 Tomans; respectively, P = 0.01). Conclusions: In STEMI patients who present during off-hours, thrombolytic therapy seems to represent a safe alternative to PPCI. Higher costs for patients with PPCI may be decreased with shorter duration of hospital stays according to guidelines.

A guideline based approach of percutaneous coronary intervention in acute myocardial infarction: Single center experience

To determine the outcomes of percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI) according to PCI guidelines. This study was conducted between January 2008 and December 2010. A total of 450 patients presenting with STEMI underwent PCI: 288 patients underwent primary PCI, and 162 patients underwent non-primary PCI. The mean age at presentation was 55 ± 11.10 years and 89.8% were male. The door-to-balloon time was 60 min in primary PCI group (288 patients). The median time between end of failed thrombolytic therapy and the rescue PCI was 420 min (95 patients) versus 810 min after successful thrombolytic therapy (35 patients). Only 32 patients underwent late PCI ⩾ 24 h and ⩽48 h without thrombolytic therapy; median time was 2160 min. In-hospital, 30 days and 6-months mortality were respectively 2.1%, 0.7% and 1.1% in primary PCI group while 2.5%, 3.2% and 2.6% in non-primary PCI group. In-hospital, 30 days and 6-months reinfarction occurred in 0.3%, 1.1% and 0.7% of patients in primary PCI group while 0.0%, 1.3% and 0.7% in non-primary PCI group respectively. In-hospital, 30 days and 6-months TVR occurred in 0.7%, 0.7% and 1.1% of patients in primary PCI group while 0.0%, 1.3% and 0.7% in non-primary PCI group respectively. This is the first report from Egyptian hospital to provide a comprehensive review of patient characteristics and outcomes of PCI for STEMI. We reported a high initial success rate, excellent short and intermediate-term outcomes.