Risk Factors for Major Adverse Cardiac Events Outcomes in Post Percutaneous Coronary Intervention during Index Admission

@#Introduction: Patients with ST-segment elevation myocardial infarction (STEMI) often undergo percutaneous coronary intervention (PCI) procedures during their index hospitalisation. However, some factors may increase the risk of major adverse cardiac event (MACE) outcomes after delaying PCI. We aimed to determine the risk factors for MACE outcomes in acute STEMI patients who had PCI during their index admission. Methods: In this retrospective single-center study, the medical records of STEMI patients who had PCI during their index hospitalisation in our facility were retrieved. At 30 days and six months post-PCI, demographic characteristics, clinical presentation, coronary risk factors, and the rate of MACE outcome were recorded and analysed. Results: This study included 91 STEMI patients. At 30 days and six months post-PCI, the rate of MACE was 10.5% and 8.0% respectively. At 30 days post-PCI, gender (p = 0.025), systolic blood pressure (p = 0.005) and heart rate (p = 0.003) were all associated with MACE outcomes. At six months, systolic blood pressure (p = 0.017), heart rate (p = 0.003), and previous coronary artery disease (CAD) (p = 0.014) were all associated with MACE. Conclusion: In acute STEMI patients, female gender, systolic blood pressure, heart rate, and a history of CAD are the risk factors for MACE outcomes after the PCI during the index admission. However, this is only single center study with short follow up period. Therefore, multi centers study and longer follow up period could provide better understanding on the factors associated with delayed PCI.

Successful Conservative Treatment of Massive Infective Endocarditis with Severe Mitral Valve Regurgitation and Septic Emboli

@#Management of complicated massive infective endocarditis (IE) in patients who are contraindicated for surgical valve replacement has long been a dilemma for many clinicians. Studies have shown that massive IE patients who were treated conservatively generally result in poorer prognosis. We report two cases of massive native valve infective endocarditis with severe mitral valve regurgitation and septic emboli that has been successfully treated conservatively. Interestingly, despite having a large vegetation and multiple septic emboli complications, none of these two cases had any positive culture or serology. Managing culture negative IE without surgical intervention pose an even greater challenge to the choice and duration of antibiotics with further long-term plans. We hope to share these case series to aid in the management dilemma of similar cases in the future.