الفهرس 
HISTORICAL BACKGROUNDOnly 14 pages are availabe for public view
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Abstract
Percutaneous coronary intervention (PCI) has become one of the most widely applied treatments in current-day cardiology, facilitating the relief of angina and (in the setting of acute ST-segment elevation myocardial infarction [STEMI]), saving lives.
Percutaneous coronary intervention (PCI) refers to both non stenting procedures and stent interventions. The introduction of percutaneous transluminal coronary angioplasty (PTCA) in the 1970s provided a nonsurgical revascularization alternative to coronary artery bypass graft surgery (CABG). However, angiographic restenosis occurred in approximately 40 percent of patients at six months after PTCA, 50 to 75 percent of whom had recurrent ischemic symptoms, most often progressive effort angina. Bare metal stents (BMS) produced a significant improvement in these parameters as the rate of angiographic restenosis fell to 20 to 30 percent and the rate of target lesion revascularization to 10 to 15 percent. As with PTCA, clinical restenosis typically occurs within the first year. After this time, recurrent ischemia is much more likely to be due to new or progressive disease at another site rather than restenosis.
Drug-eluting stents (DES) were developed to further reduce the rate of target lesion revascularization.
In this study, we did a survey for all patients admitted to 6th October health insurance hospital, cardiac catheterization department, for percutaneous coronary intervention as well as the immediate and short term follow up (up to 6th months) of these procedures.
The present prospective study included three hundred and twelve patients during the period of eight months from the first of January -2008 till the end of August 2008.
The study included all successful procedures (95.17%), (failed PCI were 18 procedures, 4.83% of total 372 procedures). All patients were followed up for 6 months post procedures. The study end points included sudden death, non-fatal MI, unstable angina and target vessel revascularization (TVR) at three and six months follow up period.
Over the study period 312 patients had successful PCI with 1 stent inserted; about 375 vessels were stented in 341 procedures. We exclude 70 patients (22.43%) whom their follow up were not completed. The remaining 242 patients (77.57%) were successfully followed up for 6 months.
In our study 183 patients (58.65%) were smokers, 174 patients had HTN (55.7%), 109 patients had DM (34.93%) while 74 patients (23.72%) had family history of CAD.
During the follow up period in the first week, 8 patients developed acute MI (3.33%) while 2 patients developed sudden death (0.82%). By the end of the follow up period, 11 patients developed acute MI (4.54%), 4 patients developed sudden death (1.65%), 8 patients had stent thrombosis (3.33%), 21 patients had ISR (8.67%) while 25 patients had repeat TVR (10.25%).
Post procedural myocardial infarction was significantly correlated with Dyslipidemia (p = 0.034) while there was no significant correlation between MI and gender, DM, HTN, smoking or family history.
Sudden death was significantly correlated with body weight (p = 0.02) and impaired LV systolic function (p = 0.034). The incidence of sudden death was higher in patient with hypertension but not statistically significant (p = 0.698).
ISR occurred in 21 patients and it was significantly correlated with long lesion (p = 0.040), small stent diameter (p = 0.039) and when the LAD was the target vessel (p = 0.020).
Stent thrombosis occurred in 8 patients (3.3%) and it was significantly correlated with long lesions (p=0.003), small stent diameter (p = 0.041) and nonuse of clopidogrel (p = 0.009).
TVR was significantly correlated with younger age (p = 0.017), higher Duke Jeopardy score (p = 0.003). TVR was higher in patients presented after myocardial infarction (p = 0.049), small stent diameter (p = 0.044) and when the LAD was the target vessel (p = 0.034).