HEART FAILURE IN PATIENTS WITH SEGMENT ELEVATION MYOCARDIAL INFARCTION UNDERGOING PRIMARY PCI AND ITS ASSOCIATION WITHISCHEMIC TIME

Abstract

Objective: To measure the frequency of heart failure in patients with segment elevation myocardial infarction treated with PPCI and to associate it with ischemic time.

Study Design: A descriptive cross-sectional study.

Place and Duration of Study: This study was conducted at the Emergency Department, Catheterization Laboratory and Coronary Care Unit of Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from May 2018 to December 2018.

Material and Methods: All patients presenting to Emergency Department with acute STEMI and undergoing PPCI were included while STEMI patients who already have established heart failure on arrival to ER were excluded from the study. All patients with the diagnosis of STEMI treated with PPCI were assessed. The initial standard 12 lead ECG, recorded immediately after the patient’s admission to the emergency department, were considered as baseline. Continuous bedside monitoring was carried out and any of the symptoms or signs of heart failure according to KILLIP class occurring over the following 72 hours were noted. All patients were separated in defined groups and were compared for different variables and will be recorded on a data collection tool.

Results: Total 500 patients of STEMI were recruited for the study out of which 384 (76.9%) were male patients while 116 (23.0%) were female patients. Mean age of the patients was found to be 58 ± 8.6 years. The most common risk factor was hypertension in 445 (89.0%) patients followed by smoking history in 373 (74.7%), Diabetes Mellitus, Family history of coronary artery disease, Grade III obesity and Previous PCI/CABG. Within ≤90 minutes of ischemic time only five patients developed heart failure in next 72 hours, 16 (3.2%) patients developed heart failure in 91-150 minutes, 49 (9.8%) patients in 151-360 minutes and 65 (13.1%) patients developed heart failure >360 minutes.

Conclusion: Total ischemic time was associated with mortality. The present study suggests that additional efforts are needed to shorten total ischemic time including patient and pre-hospital systemic delay for better prognosis after primary PCI.
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