Md. Nurul Afsar Badrul¹, Kamal Ahmed², Sufia Rahman³
1. Assistant Professor, Dept. of Cardiology, NEMC, Sylhet.
2. Assistant Professor, Dept. of Medicine, NEMC, Sylhet.
3. Professor (Emeritus), Dept. of Cardiology, NEMC, Sylhet.
Abstract
Background: Since its introduction in 1977, PCI is an important tool in the treatment of coronary artery disease (CAD). It reduced the need for coronary artery bypass graft (CABG) and recurrence of restenosis especially drug eluting stent (DES). Thus there is an interest in measuring the outcome of PCI.
Objective: To evaluate the immediate and short-term outcome of PCI.
Methods: It is a retrospective analysis of data of 90 cases (132 vessels) in NEMCH cath lab in one cardiology unit, Sylhet, Bangladesh. Immediate angiographic, procedural, clinical success, procedural complications and clinical follow up at 30days was obtained in consecutive patients who were admitted with ischemic chest pain and elective coronary angiography (CAG) for chronic stable angina.
Results: The mean age was 50.9 years (range 30-70) with 81 (90%) male and 09 (10%) female. Among CAD risk factors, hypertension 39 (43%) followed by smoking 34 (38%), dyslipidaemia 30 (33%), diabetes 29 (32%) and positive family history 09 (10%) respectively. Indication of PCI includes acute and old MI, chronic stable angina and unstable angina 43 (48%), 30 (33%) and 17 (19%) respectively. Right femoral route was used in 88 (98%) cases. Procedure done in a total of 132 vessels in 90 patients. Most of the cases were single vessels disease (SVD) (61 (68%) followed by double vessel disease (DVD) (27 (30%)), triple vessel disease (TVD) (02 (02%)) and chronic total occlusion (CTO) (02 (02%)). Type A lesion was 22 (24%), type B lesion 43 (48%) and typoe C lesion 25 (28%) respectively. Cabalt-chromium was commonly used stent (117 (88.6%), followed by drug illuting stent (DES) 12 (9.1%) and bare metal stent (BMS) 3 (2.3%). Among the sites of the stent insertion, left anterior descending (LAD) 62 (47%), right coronary lesion (RCA) 37 (28%), left circumflex artery (LCX) 33 (25%) respectively, Direct stent was given in 48 (36%) and predilatation in 84 (64%) cases. Maximum stent length was 35 mm & minimum 10mm. Maximum stent diameter was 3.5mm whereas minimum diameter 2.5mm. The mean pretreatment reference diameter was 2.55±0.20mm and post treatment diameter 2.70±0.45mm. Angiographic, procedural and clinical success rates were 100%, 98% and 98% respectively. Major adverse cardiovascular event (MACE) {periprocedural MI) occurred in 2 (2.22%) cases. Minor cardiovascular complications revealed vascular haematoma about 2 (2.22%), bleeding from access site in 1 (1.11%), transient ventricular fibrillation (VF) in 3 (3.33%) cases. There was no hospital death or emergency CABG before discharge from hospital.
Conclusion: The percutaneous coronary intervention (PCI) results of the stud shows that Angiographic, procedural and clinical success raes were excellent with a minimal MACE and event-free survival within 30 days follow up. Thus, PCI is a safe and effective method of myocardial revascularization irrespective of lesion morphology and type of stents used at immediate and 30 days follow-up.