In-hospital outcome of primary percutaneous coronary intervention for the management of acute ST-segment elevation myocardial infarction in a Bangladeshi population

Objective

This study aims to describe the different clinical outcomes of ST-Segment Elevated (STEMI) Myocardial Infarction patients of a tertiary care cardiac hospital in Bangladesh who went through Primary Per-cutaneous Coronary Intervention (PCI).

Methods

This study was conducted in the Department of Cardiology, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh. Participants of the study were 80 patients with a diagnosis of acute STEMI. Information was collected on their demographic characteristics and clinical history. Relevant physical examination and laboratory investigations were performed. Percutaneous transluminal coronary angioplasty (PTCA) ± stent implantation was done in the culprit vessel. Coronary angiograms were done before and after the procedure. They were followed up thoroughly during the hospital stay.

Results

According to the 12 lead surface ECG, 25% had an extensive anterior MI, 20% anteroseptal MI, 35% an inferior MI, 10% an anterior MI, 7.5% an inferior with right ventricular infarction and 2.5% a lateral MI. The mean door to balloon time was 95.6 ± 33.4 min. LAD was the most common (51.2%) culprit vessel followed by RCA (38.5%) and LCX (10.2%).We compare, (1) ECG changes (return of ST segment towards isoelectric line in mm). (2) Improvement of TIMI flow. (3) Improvement of LV function (LVEF measured by echocardiography). (4) Complications (general, vascular). There was significant improvement in ECG changes (return of ST segment towards isoelectric line in mm). Pre and post-procedural mean ST elevation was 6.6 ± 2.7 mm and 0.5 ± 0.8 mm. Examining improvement of TIMI flow after the PCI, 87.5% had TIMI-3 flow, 7.5% had TIMI-2 flow, 2.5% had TIMI-1 and 2.5% had TIMI-0 flow (P < 0.001). The pre-procedural mean left ventricular ejection fraction (LVEF) was 41.6 ± 4.2% and the post-procedural mean LVEF was 51.8 ± 5.1% (P < 0.01). There were, 7.7% with post-procedural general complications and no vascular complications in any of the patients. In-terms of major adverse cardiac events (MACE), only 2(2.5%) patients died, one was due to a cardiac arrest 8 h after the procedure, and another was due to ventricular fibrillation followed by asystole 2 h after the procedure.

Conclusion

The study results show that with limited facilities and financial abilities, patients receiving Primary PCI had good in hospital outcomes which is similar to other studies done in different countries. So primary PCI may be the preferred method of reperfusion for the management of STEMI in the current Bangladeshi setting.