Short outcome in Patients with Non–ST-Elevation Myocardial Infarction (NSTEMI) after multi-vessel Percutaneous Intervention
Article Sidebar
Main Article Content
Abstract
Background: Non-ST elevation myocardial infarction (NSTEMI) presents a significant clinical challenge, particularly in the context of multi-vessel disease (MVD), which complicates patient management and impacts prognosis. The variability in short-term outcomes following percutaneous coronary intervention (PCI) for NSTEMI patients with MVD necessitates a deeper understanding of the associated risk factors and outcomes.
Objective: To evaluate the risk factors and short-term clinical outcomes of NSTEMI patients after multi-vessel PCI, identifying predictors of major adverse cardiovascular events (MACE) and cardiac death within this population.
Methods: This retrospective study was conducted at Lady Reading Hospital, Peshawar, from January 2022 to December 2022, including 100 NSTEMI patients who underwent multi-vessel PCI. The Institute Review Board approved the study, adhering to the Declaration of Helsinki. Data on demographics, clinical characteristics, and outcomes were collected. Multi-vessel disease was defined by ≥50% narrowing in the left main coronary artery or ≥70% in at least two major epicardial coronary arteries. Statistical analysis employed SPSS Version 25.0, with Kaplan–Meier and Cox regression analyses determining the impact of various predictors on short-term outcomes.
Results: The mean age of participants was 65.6 ± 10.5 years, with a BMI of 22.75 ± 4.67 kg/m^2. Diabetic and ischemic heart disease prevalence was 30.4% and 26.9%, respectively. Multi-vessel disease was observed in 66.2% of patients. Short-term mortality and MACE rates were significantly influenced by factors such as age, lower BMI, renal dysfunction, and left ventricular dysfunction. The cumulative incidence of MACE within 30 days post-PCI was notably higher in patients with these risk factors.
Conclusion: NSTEMI patients undergoing multi-vessel PCI face a significant risk of short-term adverse outcomes. Key predictors of increased risk include advanced age, diabetes, ischemic heart disease, and renal dysfunction. Tailored management strategies focusing on these high-risk groups are essential for improving short-term prognosis.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Sarkar WS, Grigg JJ, Lee. TIMI Grade Flow. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.
Bailleul C, Aissaoui N, Cayla G, Dillinger J, Jouve B, Schiele F, et al. Prognostic impact of prepercutaneous coronary intervention TIMI flow in patients with ST-segment and non-ST-segment elevation myocardial infarction: Results from the FAST-MI 2010 registry.
Wang TY, Zhang M, Fu Y, Armstrong PW, Newby LK, Gibson CM, et al. Incidence, distribution, and prognostic impact of occluded culprit arteries among patients with non-ST-elevation acute coronary syndromes undergoing diagnostic angiography.
Bahrmann P, Rach J, Desch S, Schuler GC, Thiele H. Incidence and distribution of occluded culprit arteries and impact of coronary collaterals on outcome in patients with non-ST-segment elevation myocardial infarction and early invasive treatment strategy.
De Luca G, Ernst N, Zijlstra F, van 't Hof AWJ, Hoorntje JCA, Dambrink JEH, et al. Preprocedural TIMI flow and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol. 2004 Apr 21;43(8):1363-1367.
De Luca G, Ernst N, van Hof AWJ, Ottervanger JP, Hoorntje JCA, Dambrink JEH, et al. Preprocedural Thrombolysis in Myocardial Infarction (TIMI) flow significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute anterior myocardial infarction treated by primary angioplasty.
De Luca G, Brener SJ, Mehran R, Lansky AJ, McLaurin BT, Cox DA, et al. Implications of pre-procedural TIMI flow in patients with non ST-segment elevation acute coronary syndromes undergoing percutaneous coronary revascularization: insights from the ACUITY trial. Int J Cardiol. 2013 Aug;167(3):727-732.
Kim D, Her S, Park M, Cho JS, Kim T, Kang H, et al. Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction. Int Heart J. 2017 Oct;58(5):674-685.
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).
Roffi M, Patrono C, Collet J, Mueller C, Valgimigli M, Andreotti F, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC).
Navarese EP, De Servi S, Gibson CM, Buffon A, Castriota F, Kubica J, et al. Early vs. delayed invasive strategy in patients with acute coronary syndromes without ST-segment elevation: a meta-analysis of randomized studies.
Li Y, Zhang Z, Xiong X, Cho WC, Hu D, Gao Y, et al. Immediate/Early vs. Delayed Invasive Strategy for Patients with Non-ST-Segment Elevation Acute Coronary Syndromes: A Systematic Review and Meta-Analysis.
Mehta SR, Granger CB, Boden WE, Steg PG, Bassand J, Faxon DP, et al. Early versus delayed invasive intervention in acute coronary syndromes.
Fox KAA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE).
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth Universal Definition of Myocardial Infarction (2018).
Vo MN, Brilakis ES, Kass M, Ravandi A. Physiologic significance of coronary collaterals in chronic total occlusions.
Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, et al. Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association.
Austin PC. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies.
Hung C, Chen Y, Huang C, Lin M, Yeh C, Li H, et al. Prevalence and outcome of patients with non-ST segment elevation myocardial infarction with occluded “culprit” artery - a systemic review and meta-analysis.
Karwowski J, Gierlotka M, Gąsior M, Poloński L, Ciszewski J, Bęćkowski M, et al. Relationship between infarct artery location, acute total coronary occlusion, and mortality in STEMI and NSTEMI patients. Pol.
Ayad SW, El Zawawy TH, Lotfy MI, Naguib AM, El Amrawy AM. Incidence and impact of totally occluded culprit coronary artery in patients with non-ST segment elevation myocardial infarction acute coronary syndrome.
Khan AR, Golwala H, Tripathi A, Bin Abdulhak AA, Bavishi C, Riaz H, et al. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis.
Stribling WK, Kontos MC, Abbate A, Cooke R, Vetrovec GW, Dai D, et al. Left circumflex occlusion in acute myocardial infarction (from the National Cardiovascular Data Registry).