PPCI OUTCOMES

Abstract

Objectives: Primary percutaneous coronary intervention (PPCI) is the standard of care for ST-elevation myocardial infarction (STEMI) worldwide. Recommended by the latest guidelines (1). In Pakistan only a handful centres offer PPCI services, many others rely on thrombolysis as the reperfusion strategy for STEMI patients which has been shown to be inferior to primary PCI (2). In our province the PPCI facility is even harder to offer where infrastructure and economic conditions of the public is lagging behind many areas in the country. Ours is a study from a public sector hospital in its infancy. We present our data of a single centre and believe that it will help shape the policy of the government in favour of expanding PPCI facilities. To share the primary PCI data of our centre.

Methodology: It was a retrospective observational study. All comers who underwent PPCI for STEMI in Peshawar Institute of Cardiology from March 2022 to August 2022were enrolled. All procedures were performed by experienced interventional cardiologists or their fellows under their direct supervision.

Results: A total of 337 patients were enrolled in the study. The mean age was 53 ± 16 years. 73 % (n = 246) were males. Most commonly involved culprit artery was LAD (47%) followed by RCA (34%). 16.9% (n = 57) patients had triple vessel disease, 35 % (n = 119) double vessel disease and 47.7% (n = 161) had only one vessel disease. LMS disease was diagnosed in 18 (5.3%) patients, out of which 4 (1.1%) were stented during the index procedure. In-hospital mortality was 3% (n = 10), out of which 6 (1.8 %) patients were in cardiogenic shock and all were on inotropic support. Four patients (1.1%) needed intubation and balloon pump was used in another 4 (1.1 %) patients. Second and third generation DES were used in 86% (n = 290), POBA in 08% (n = 27), urgent surgical referral was done in 03 % (n = 10) while in 03% (n = 10) patients no stenting was done. Intravascular ultrasound was used in 4 (1.1%) cases.

Conclusion: Primary PCI can be offered in public sector hospital to our population. The need of the hour is to delegate more resources to this life saving procedure.