RESUMO
BACKGROUND: Patient unawareness about acute myocardial infarction, its complications and the benefits of early revascularization is a crucial point that determines the outcomes. Moreover, the relationship between socioeconomic factors and patient presentation to primary percutaneous coronary intervention (PPCI) has not been fully studied. OBJECTIVES: Our objective was to investigate whether or not patient unawareness and other socioeconomic factors impact patient presentation to PPCI. METHODS: The study comprised 570 patients with ST-segment elevation myocardial infarction (STEMI) revascularized by PPCI. The patients were classified into two groups according to the total ischemia time (the time from STEMI symptom onset to balloon dilatation); group I: Patients with early presentation (1-12 hours). Group II: Patients with late presentation (>12-24 hours). Socioeconomic factors, clinical outcomes including mortality and major adverse cardiac events (MACE) were evaluated in each group. A p-value < 0.05 was considered statistically significant. RESULTS: There are different socioeconomic factors affecting patient presentation to PPCI. Multivariate regression analysis identified the independent socioeconomic predictors as following: low educational level - OR 4.357 (CI95% 1.087-17.47, p=0.038), social isolation - OR 4.390 (CI95% 1.158-16.64, p=0.030) and unawareness about the benefits of early revascularization - OR 4.396 (CI95% 1.652-11.69, p=0.003). Mortality and MACE were higher in group II. CONCLUSION: Patient unawareness and low socioeconomic status were associated with late presentation to PPCI with more adverse outcomes.
FUNDAMENTO: O desconhecimento do paciente sobre o infarto agudo do miocárdio, suas complicações e os benefícios da revascularização precoce é um ponto crucial na determinação dos desfechos. Além disso, a relação entre fatores socioeconômicos e apresentação do paciente à intervenção coronária percutânea primária (ICPP) não foi totalmente estudada. OBJETIVOS: Nosso objetivo foi investigar se o desconhecimento do paciente e outros fatores socioeconômicos impactam na apresentação do paciente à ICPP. MÉTODOS: O estudo compreendeu 570 pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST) revascularizados por ICPP. Os pacientes foram classificados em dois grupos de acordo com o tempo total de isquemia (tempo desde o início dos sintomas do IAMCSST até a dilatação com balão); grupo I: Pacientes com apresentação precoce (1-12 horas). Grupo II: Pacientes com apresentação tardia (>12-24 horas). Fatores socioeconômicos, desfechos clínicos incluindo mortalidade e eventos cardíacos adversos maiores (ECAM) foram avaliados em cada grupo. O valor de p < 0,05 foi considerado estatisticamente significante. RESULTADOS: Existem diferentes fatores socioeconômicos que afetam a apresentação do paciente à ICPP. A análise de regressão multivariada identificou os preditores socioeconômicos independentes da seguinte forma: baixa escolaridade - OR 4,357 (IC95% 1,08717,47, p=0,038), isolamento social - OR 4,390 (IC95% 1,15816,64, p=0,030) e desconhecimento sobre os benefícios da revascularização precoce - OR 4,396 (IC95% 1,65211,69, p =0,003). A mortalidade e ECAM foram mais altas no grupo II. CONCLUSÃO: O desconhecimento do paciente e o baixo nível socioeconômico foram associados à apresentação tardia para a ICPP, com desfechos mais adversos.
Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Fatores Socioeconômicos , Resultado do TratamentoRESUMO
BACKGROUND: No-reflow phenomenon after primary percutaneous coronary intervention is a common condition affecting the outcomes; therefore, studying its predictive factors is helpful in identifying patients at high risk. Our objective was to investigate the impact of the total ischemia time on no-reflow phenomenon and its correlation to thrombolysis in myocardial infarction flow grade after primary percutaneous coronary intervention. METHODS: This study was conducted on 545 patients with ST-elevation myocardial infarc-tion who underwent PPCI; the patients were divided into two groups according to the incidence of no-reflow, TIMI flow ≤2 was considered no-reflow. The time interval from chest pain onset to balloon dilatation was assessed and correlated to thrombolysis in myocardial infarction flow grade. RESULTS: The incidence of no-reflow was 13.9%; thrombolysis in myocardial infarction flow≤2 occurred in 76 patients. Multivariate regression analysis showed that advanced age>65 years, the total ischemia time >6 h, high thrombus burden, and cardiogenic shock were the independent predictors of no-reflow phenomenon. Spearman's correlation analysis showed a significant negative correlation between the total ischemia time and thrombolysis in myocardial infarction flow grade (r = -351 and P-value = .001). CONCLUSION: The time delay is the main limitation of achieving thrombolysis in myocardial infarction 3 flow after primary percutaneous coronary intervention. The total ischemia time has a significant negative correlation with thrombolysis in myocardial infarction flow grade after primary percutaneous coronary intervention.
Assuntos
Infarto do Miocárdio , Fenômeno de não Refluxo , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Idoso , Angiografia Coronária/efeitos adversos , Humanos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/efeitos adversosRESUMO
Background: Stress hyperglycemia is a common finding during acute myocardial infarction and associated with poor prognosis. To reduce the occurrence of no-reflow, prognostic factors must be identified before primary percutaneous coronary intervention (PPCI). Our objective was to investigate the impact of stress hyperglycemia in non-diabetic and diabetic patients on no-reflow phenomenon after PPCI. Methods: The study comprised 480 patients with ST elevation myocardial infarction (STEMI) who were managed by PPCI. Patients were classified into two groups according to thrombolysis in myocardial infarction (TIMI) flow grade: Group I (Patients with normal flow, TIMI 3 flow) and Group II (Patients with no-reflow, TIMI 0-2 flow). Patients were analyzed for clinical outcomes including mortality and major adverse cardiac events. Results: Incidence of stress hyperglycemia was 14.8% in non-diabetic patients and 22.2% in diabetic patients; the incidence of no-reflow phenomenon was 13.5% and no-reflow was significantly higher in patients with stress hyperglycemia. Multivariate regression analysis identified the independent predictors of no-reflow phenomenon: stress hyperglycemia OR 3.247 (CI95% 1.656-6.368, P = 0.001), Killip class >1 OR 1.893 (CI95% 1.004-3.570, P = 0.049) and cardiogenic shock OR 3.778 (CI95% 1.458-9.790, P = 0.006). Conclusion: Stress hyperglycemia was associated with higher incidence of no-reflow phenomenon. The independent predictors of no-reflow were stress hyperglycemia, Killip class >1 and cardiogenic shock.
Assuntos
Diabetes Mellitus , Hiperglicemia , Fenômeno de não Refluxo , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Angiografia Coronária/efeitos adversos , Diabetes Mellitus/epidemiologia , Humanos , Hiperglicemia/epidemiologia , Fenômeno de não Refluxo/complicações , Fenômeno de não Refluxo/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Choque Cardiogênico/complicaçõesRESUMO
Resumo Fundamento: O desconhecimento do paciente sobre o infarto agudo do miocárdio, suas complicações e os benefícios da revascularização precoce é um ponto crucial na determinação dos desfechos. Além disso, a relação entre fatores socioeconômicos e apresentação do paciente à intervenção coronária percutânea primária (ICPP) não foi totalmente estudada. Objetivos: Nosso objetivo foi investigar se o desconhecimento do paciente e outros fatores socioeconômicos impactam na apresentação do paciente à ICPP. Métodos: O estudo compreendeu 570 pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST) revascularizados por ICPP. Os pacientes foram classificados em dois grupos de acordo com o tempo total de isquemia (tempo desde o início dos sintomas do IAMCSST até a dilatação com balão); grupo I: Pacientes com apresentação precoce (1-12 horas). Grupo II: Pacientes com apresentação tardia (>12-24 horas). Fatores socioeconômicos, desfechos clínicos incluindo mortalidade e eventos cardíacos adversos maiores (ECAM) foram avaliados em cada grupo. O valor de p < 0,05 foi considerado estatisticamente significante. Resultados: Existem diferentes fatores socioeconômicos que afetam a apresentação do paciente à ICPP. A análise de regressão multivariada identificou os preditores socioeconômicos independentes da seguinte forma: baixa escolaridade - OR 4,357 (IC95% 1,087-17,47, p=0,038), isolamento social - OR 4,390 (IC95% 1,158-16,64, p=0,030) e desconhecimento sobre os benefícios da revascularização precoce - OR 4,396 (IC95% 1,652-11,69, p =0,003). A mortalidade e ECAM foram mais altas no grupo II. Conclusão: O desconhecimento do paciente e o baixo nível socioeconômico foram associados à apresentação tardia para a ICPP, com desfechos mais adversos.
Abstract Background: Patient unawareness about acute myocardial infarction, its complications and the benefits of early revascularization is a crucial point that determines the outcomes. Moreover, the relationship between socioeconomic factors and patient presentation to primary percutaneous coronary intervention (PPCI) has not been fully studied. Objectives: Our objective was to investigate whether or not patient unawareness and other socioeconomic factors impact patient presentation to PPCI. Methods: The study comprised 570 patients with ST-segment elevation myocardial infarction (STEMI) revascularized by PPCI. The patients were classified into two groups according to the total ischemia time (the time from STEMI symptom onset to balloon dilatation); group I: Patients with early presentation (1-12 hours). Group II: Patients with late presentation (>12-24 hours). Socioeconomic factors, clinical outcomes including mortality and major adverse cardiac events (MACE) were evaluated in each group. A p-value < 0.05 was considered statistically significant. Results: There are different socioeconomic factors affecting patient presentation to PPCI. Multivariate regression analysis identified the independent socioeconomic predictors as following: low educational level - OR 4.357 (CI95% 1.087-17.47, p=0.038), social isolation - OR 4.390 (CI95% 1.158-16.64, p=0.030) and unawareness about the benefits of early revascularization - OR 4.396 (CI95% 1.652-11.69, p=0.003). Mortality and MACE were higher in group II. Conclusion: Patient unawareness and low socioeconomic status were associated with late presentation to PPCI with more adverse outcomes.
RESUMO
Background: Contrast induced nephropathy (CIN) is considered one of the most common causes of hospital acquired renal failure and severely affects morbidity and mortality. Our objective was to investigate incidence, predictors and outcomes of CIN in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Methods: The study was conducted on 550 patients with STEMI subjected to PPCI. Patients were classified into two groups according to the occurrence of CIN; group I (Patients without CIN) and group II (Patients with CIN). The two groups were assessed for the clinical outcomes including mortality and major adverse cardiac events (MACE). Results: Incidence of CIN was 10.6%, multivariate regression analysis identified the independent predictors of CIN including; age > 60 years OR 6.083 (CI95% 3.143-11.77, P = 0.001), presence of diabetes mellitus OR 2.491 (CI95% 1.327-4.675, P = 0.005), non-steroidal anti-inflammatory drugs (NSAIDs) use OR 2.708 (CI95% 1.393-5.263, P = 0.003), the volume of contrast agent >200 ml OR 6.543 (CI95% 3.382-12.65, P = 0.001) and cardiogenic shock OR 4.514 (CI95% 1.738-11.72, P = 0.002). Mortality was higher in group II than group I (11.9% vs. 4.4% respectively, P = 0.015). The incidence of MACE were higher in group II than group I (heart failure; 18.6% vs. 7.3%, cardiac arrest; 8.5% vs. 2.8% and cardiogenic shock; 16.9% vs. 6.9% with P. value = 0.003, 0.024, 0.007 respectively). Conclusion: Contrast induced nephropathy was associated with increased morbidity and mortality. The independent predictors of CIN were advanced age, diabetes mellitus, NSAIDs use, the volume of contrast agent >200 ml and cardiogenic shock.
