AN OUTCOME OF 200 CASES OF PRIMARY PCI - A SINGLE OPERATORS EXPERIENCE OF A TERTIARY CARE CENTRE

Abstract

Objective: To evaluate the demographics and in hospital outcomes of the patients presenting with acute STEMI in a tertiary care cardiac centre.

Study Design: Single-centre, prospective observational study.

Place and Duration of Study: The study was carried out in Armed Forces Institute of Cardiology – National Institute of Heart Diseases (AFIC-NIHD) over a period of 14 months from January 2015 to march 2016.

Material and Methods: We collected data of two hundred patients who underwent Primary PCI by a single operator (the index author). Acute myocardial infarction registry by R & D Department was used as a data collection tool. Patients with acute ST segment elevation myocardial infarction (STEMI) reporting to the emergency department of AFIC/NIHD were included in the study. The patients were examined before discharge from the hospital for any complication. Study endpoints included procedure success rate, vascular complications at access site, and major adverse cardiac and cerebrovascular events during hospitalization.

Results: Mean age of the patients was 51 ± 16.8 years and males were more in number 128(64 %) as compared to females 72(36%).92 (46%) patients were found to be diabetic, 81(40.5%) hypertensive, and 91 (45.5%) patients were smokers. Radial and femoral approach was used in 183(91.5%) and 17 (8.5 %) patients respectively. Anterior, inferior and lateral myocardial infarction was seen in 128 (64%), 67 (33.5%) and 5 (2.5%) patients respectively .Left anterior descending (LAD) was the commonest culprit artery in 128 (64%) followed by right coronary artery (RCA) & left circumflex artery (LCX) in 57 (28.5%) and 15 (7.5%) cases respectively . The procedural success rate was 96.3%. Overall mortality was seen in 3(1.5%) cases.Reinfarct and Stroke was seen in4 (2.0%) and 1 (0.5%) patients respectively. Major and minor bleeding was seen in 1(0.5%) and17 (8.5%) patients. The median time from- onset of symptoms to presentation was 170 minutes±93min and the Median door to balloon time was 51.75 ± 5.6 min.

Conclusion: Our study has shown that PPCI is feasible with good outcomes (High success rate with low mortality rates) in our set up. Even though the recommended door-to-balloon time can be achieved in most of the patients the total ischemic time remained long. Increased public awareness is needed to improve outcomes in acute MI.