Comparison of official hours versus non-official hours: percutaneous coronary intervention in acute ST-elevation myocardial infarction patients.

BACKGROUND: Percutaneous coronary intervention (PCI) is now a favorable treatment for acute ST elevation myocardial infarction (STEMI). However, in non-official hours (non-OH), this modality of treatment has a questionable outcome because of the treatment delay. OBJECTIVE: To compare the outcomes of PCI during official hours (OH) with non-OH in acute STEMI patients. MATERIAL AND METHOD: A prospective consecutive registry of PCI in acute ST-elevation MI patients at King Chulalongkorn Memorial Hospital from May 1999 to December 2003 were analyzed. Kaplan Meier survival analysis was used to determine the in-hospital mortality. Multivariate analysis was used to determine the prognostic factors for in-hospital mortality. RESULTS: Two hundred and fifty six consecutive patients (OH-107, non-OH-149) who underwent PCI for acute STEMI were enrolled. Their mean age (61.9 +/- 12.2 vs 60.6 +/- 12.8 y, p = ns), male gender (73.8% vs 73.2%, p = ns), history of diabetes (30.2% vs 33.8%, p = ns), severity of the patients (percent of patients in Killip IV--22.4 vs 21.5, p = ns), ejection fraction (48.7 +/- 15.1 vs 45.9 +/- 14.7, p = ns), cardiopulmonary resuscitation prior PCI (15.0% vs 14.2%, p = ns), anterior MI (55.1% vs 51.0%, p = ns) were similar in both groups. Hypertension was slightly less common (39.6% vs 52.7%, p = 0.04) but smoking was more common (62.6% vs 49.0%, p = 0.03) in OH group. Door to balloon time and decision to balloon time were significantly shorter in the OH group than the non-OH group (67.9 +/- 47 vs 119.6 +/- 83 min, p < 0.001 and 60.8 +/- 35 vs 98.3 min, p < 0.001). However, the total delayed time was not statistically significantly different (402 +/- 316 vs 424 +/- 215, p = 0.55). Angiographic success rate was achieved in 98.1% for the OH group and 94.7% in the non-OH group (p = ns). In-hospital mortality rate was 10.3% and 10.7% respectively. CONCLUSION: The door to balloon time for PCI in acute STEMI patients in the non-OH group was longer than the OH group; however, the total delayed time was not different. The in-hospital mortality rate was similar.

Percutaneous carotid stenting: a novel treatment for carotid artery stenosis.

BACKGROUND: Stroke is currently a leading cause of physical disability and carries a high mortality rate. About 20% of ischemic stroke is caused by carotid artery stenosis. Carotid stenting is now another therapeutic modality for the treatment of extracranial carotid artery stenosis. MATERIAL AND METHOD: All patients who underwent carotid stenting at King Chulalongkorn Memorial Hospital from March 2001 to December 2002 were analyzed. The case success was determined by residual angiographic stenosis of less than 30% without any major adverse cardiovascular events such as death, stroke or emergency re-intervention. RESULTS: Carotid stenting was performed in 6 patients with 9 vessels disease. Their mean age was 71.8 years. Hypertension was the most common risk factor detected in all patients, followed by smoking (83.3%), dyslipidemia (83.3%) and diabetes (33.3%). One third of the patients had a prior history of stroke or transient ischemic attack and 16.6% occurred within 6 months. Five of six (83.3%) had severe coronary disease and required coronary artery bypass grafting after successful carotid stenting. The procedures were successful in all patients. The average percent of stenosis was reduced from 83.2% to 9.4%. The distal protection device was used in one-third of the cases. The average procedure time was 63.6 minutes and fluoroscopic time was 16.6 minutes. There was no evidence of stroke or death after the procedures. Only one (11.1%) developed hypotension and bradycardia that required intravenous fluid loading and inotropic support for 24 hours. CONCLUSION: Carotid stenting at our center is feasible and considered to be a safe procedure for the treatment of carotid artery stenosis. This procedure is another alternative treatment and may be superior to carotid endarterectomy, the standard treatment of carotid artery stenosis.

Worse prognosis for women who underwent primary percutaneous coronary intervention for acute ST-elevation myocardial infarction.

BACKGROUND: Many reports have shown that female gender carries a worse prognosis when developing acute myocardial infarction (MI), whether or not reperfusion therapy is used. The primary percutaneous coronary intervention (1-PCI) is currently a preferable treatment for acute ST-elevation MI. However, the data concerning the difference between the outcomes in the treatment of the disease in men and women in Thailand is still insufficient. MATERIAL AND METHOD: A prospective registry of acute ST-elevation MI patients who underwent 1-PCI at King Chulalongkorn Memorial Hospital from June 1999 to December 2002 were analyzed. Kaplan Meier survival analysis is used to determine the in-hospital mortality. RESULTS: The consecutive 184 (F-52, M-131) patients who underwent 1-PCI were recruited. Female subjects were older (66.6 +/- 12 y versus 59.0 +/- 11.6 y, p < 0.01); they also had higher percentage of diabetes (45.1 versus 27.1, p < 0.01), but a fewer number of smoker (17.7 versus 66.2, p < 0.001). The percentage of patients who had cardiogenic shock tended to be higher in women (34.6 versus 19.9, p = 0.08); however, the number of anterior wall MI and ejection fraction were not different. The mean door to balloon time (109 +/- 95 versus 99 +/- 68 minutes) and pain to balloon time (454 +/- 271 versus 372 +/- 298 minutes) were not different in both groups. The angiographic success with TIMI 3 flow was achieved in 92.3% for females and 86.9% for the males. The in-hospital mortality was significantly higher in females (23.1 versus 6.1, p = 0.002). Univariate analyses demonstrated that the feminine gender, cardiogenic shock, smoking, ejection fraction less than 40, cardiac arrest prior PCI and angiographic were the predictors for in-hospital mortality. When using multivariate analyses by Cox proportional model, only cardiogenic shock, history of hypertension and angiographic success were the significant predictors. Women had 2.15 times of in-hospital mortality higher than males; however, the confidence interval cross-over 1 (0.74-6.42) and p value was 0.16. CONCLUSION: Females tend to have a poor prognosis when they develop acute ST-elevation MI which requires treatment with 1-PCI.