الفهرس 
Acute myocardial infarctionOnly 14 pages are availabe for public view
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Abstract
Summary
The treatment of STEMI includes prompt revascularization and medical therapy. Revascularization can be performed by either primary percutaneous coronary intervention (PCI), fibrinolytic therapy (thrombolytic therapy) or surgically. Primary PCI is preferred if available within a reasonable time-frame (door-to-balloon less than 90 minutes).
Primary PCI defined as an emergent percutaneous catheter intervention in the setting of STEMI, without previous fibrinolytic treatment is the preferred reperfusion strategy in patients with STEMI, provided it can be performed expeditiously (i.e. within guideline-mandated times), by an experienced team, and regardless of whether the patient presents to a PCI-capable hospital.
Primary PCI is the most reliable method of re-opening of the culprit artery in the majority of patients. Coronary artery patency can be confirmed, secured and maintained. There is a lower risk of major, particularly intracerebral, bleeding than with fibrinolytic therapy. For PPCI to provide reliable, timely reperfusion a fully equipped catheter laboratory staffed by an experienced team must be available 24-h per day.
This is a prospective study included 272 patients with STEMI who were eligible for primary PCI. The study was conducted at department of cardiology-Benha University hospital and National Heart Institute in the period from April 2015 to October 2015. We aimed to evaluate our status as regard primary PCI frequency, complication and outcomes during hospital stay in two Egyptian centers.
Patients subjected to the following:-
History taking and general and local examination, E.C.G, ECHO:- include EF, wall motion abnormality, Laboratory:-including cardiac biomarkers, s.creatinine, Door to balloon time and Coronary angiography:- all data of PCI procedures will be recorded such as approach, guiding catheter, guide wire, Ballon, stent, TIMI flow, procedural complication, lesion and inhospital morbidity and mortality. All data will be intabulated and statistically analysed.
In current study the mean age was 52.71 years. 86.76% were male patients.
In the present study risk factors were 66.54% were smokers, 39.71% had diabetes, 49.63% had hypertension, 47.06% had dyslipidemia, 51.10% had positive family history, 5.51% did prior PCI, 4.78% had history of CVA and there was not history of prior CABG, this percentages out of 272 patients.
Anterior wall MI most common type 68.38% patients, Lateral wall infarction occurred in 5.51% patients, inferior wall infarction reported in 21.32% patients, in-right and inf-post wall infarction occurred in 1.84 and 1.10% patients had inf-posterior wall infarction out of 272 patients of the study.
88.60% patients were KILLIP class I, 8.82% patients were KILLIP class II, 2.57% patients were KILLIP class IV out of 272 patients of the study.
Mean EF was 49.6%, with range 46-56%. Mean CK was 675.67 and mean Creatinine 1.13.
Mean DTB time (the PCI related delay) was 64.33 minutes, range 50-90 minutes, 59.56% patients their DTB within 60 minutes and 40.44% patients their DTB from 60-90 minutes.
The target artery was LAD in 68.01% of all cases while RCA in 20.22% of cases, LCX in 10.66% cases, Diagonal 0.37% case and there was 0.74% cases were normal out of 272 patients. 64.70% of patients had a single vessel disease, 2 vessels disease were detected in 20.96% of patients, while 3 vessels disease were detected in 12.50% of patients, 4 vessel occurred in 1.10% of patients and there was 0.74% patients were normal out of 272 patients of the study.
JL guiding catheter was used in 40.50% patients, EPU guiding catheter was used in 18.99%, XP guiding catheter was used in 16.84%, JR guiding catheter was used in 20.43% and there was 3.22% cases did not use guiding catheter out of 272 patients of the study. Non-hydrophilic wires used in 85.66%patients, hydrophilic wires used in 11.03% and there was 3.31% cases did not use wire out of 272 patients of our study.
Balloon dilation done in 66.54% out of 272 patients either balloon dilation without stenting (PTCA) in 6.62% or balloon dilation with deferred stent in 7.35%, balloon dilation with stenting 52.57% patients. Implantation of Bare-metal stent was performed in 83.45% of all patients, implantation of DES stent was used in 1.47% and 15.07% patients did not use stent. 64.70% patients had 1 stent while 19.85% patients had 2 stents and 0.37% patient had 3 stents out of 272 patients of the study.
Glycoprotein inhibitors were used in 29.41% cases. Manual aspiration devices were used in 41.18% of patients of 272 cases, large thrombus burden or impaired TIMI flow were the main indications.
Pre PCI TIMI flow 0 was detected in 80.15% patients, TIMI I in14.71% patients while TIMI II flow in1.84% patients and TIMI III flow in3.31% patients out of 272 cases of the study. TIMI flow at the end of primary PCI was III in89.71% patients and II in5.15% patients and TIMI 0 (failed PCI) was in5.15% out of 272 cases of the study.
87.13%patients out of 272 patients either culprit (PTCA) in6.62% patients or culprit (PTCA and deferred stent) in7.35%patients, culprit (stent and PTCA) in 52.57%patients or culprit (stent without PTCA) in 20.59%, total revascularization done in 4.41% patients out of 272 cases, there was 5.15% failed PCI and 3.31% patients was conservative.
Minor bleeding occurred in 5.51% patients, 3.68% of patients had arrhythmia, 11.40% of patients developed heart failure out of 272 cases of the study, no reported cases of re-infarction or need for urgent PCI during the hospital stay. Mortality cases due to cardiogenic shock were reported in1.10% patients out of 272 cases of the study.