Predilation Ballooning in High Thrombus Laden STEMIs: An Independent Predictor of Slow Flow/No-Reflow in Patients Undergoing Emergent Percutaneous Coronary Revascularization

Background. Distal embolization due to microthrombus fragments formed during predilation ballooning is considered one of the possible mechanisms of slow flow/no-reflow (SF/NR). Therefore, this study aimed to compare the incidence of intraprocedure SF/NR during the primary percutaneous coronary intervention (PCI) in patients with high thrombus burden (≥4 grade) with and without predilation ballooning for culprit lesion preparation. Methodology. This prospective descriptive cross-sectional study included patients with a high thrombus burden (≥4 grades) who underwent primary PCI. Propensity-matched cohorts of patients with and without predilation ballooning in a 1 : 1 ratio were compared for the incidence of intraprocedure SF/NR. Results. A total of 765 patients with high thrombus burden undergoing primary PCI were included in this study. The mean age was 55.75 ± 11.54 years, and 78.6% (601) were males. Predilation ballooning was conducted in 346 (45.2%) patients. The incidence of intraprocedure SF/NR was significantly higher (41.3% vs. 27.4%; p<0.001) in patients with predilation ballooning than in those without preballooning, respectively. The incidence of intraprocedure SF/NR also remained significantly higher for the predilation ballooning cohort with an incidence rate of 41.3% as against 30.1% (p=0.002) for the propensity-matched cohort of patients without predilation ballooning with a relative risk of 1.64 (95% CI: 1.20 to 2.24). Moreover, the in-hospital mortality rate remained higher but insignificant, among patients with and without predilation ballooning (8.1% vs. 4.9%; p=0.090). Conclusion. In conclusion, predilation ballooning can be associated with an increased risk of incidence of intraprocedure SF/NR during primary PCI in patients with high thrombus burden

One-year major adverse cardiovascular events among same-day discharged patients after primary percutaneous coronary intervention at a tertiary care cardiac centre in Karachi, Pakistan: a prospective observational study

Objective Knowledge regarding the short-term outcomes after same-day discharge (SDD) post primary percutaneous coronary intervention (PCI) is lacking. In this study, we evaluated 1-year major adverse cardiovascular events (MACE) among SDD patients after primary PCI.Design 1-year follow-up analysis of a subset of patients from an existing prospective cohort study.Setting Tertiary care cardiac hospital in Karachi, Pakistan.Participants Consecutive patients, from August 2019 to July 2020, with ST segment elevation myocardial infarction who had undergone primary PCI with SDD (within 24 hours) after the procedure by the treating physician and with at least one successful follow-up up to 1 year.Outcome measure Cumulative MACE during follow-up at the intervals of 1 week, 1 month, 6 months and 1 year.Results 489 patients were included, with a gender distribution of 83.2% (407) male patients and a mean age of 54.58±10.85 years. Overall MACE rate during the mean follow-up duration of 326.98±76.71 days was 10.8% (53), out of which 26.4% (14/53) events occurred within 6 months of discharge and the remaining 73.6% (39/53) occurred between 6 months and 1 year. MACE was significantly higher among patients with a Zwolle Risk Score (ZRS) ≥4 at baseline, with an incidence rate of 21.9% (16/73) vs 8.9% (37/416; p=0.001) in patients with ZRS≤3 (relative risk 2.88 (95% CI 1.5 to 5.5)).Conclusion A significant burden of short-term MACE was identified among SDD patients after primary PCI; most of these events occurred after 6 months of SDD, mainly among patients with ZRS≥4. A systematic risk assessment based on risk stratification modalities such ZRS could be a viable option for SDD patients with primary PCI

Obesity paradox: a myth or reality, time to reveal the fact in a South Asian cohort presenting with STE-ACS undergoing primary percutaneous coronary intervention

Objectives Obesity is a globally well-established risk factor for atherosclerotic cardiovascular diseases; however, some studies have witnessed survival benefits among obese patients and this phenomenon is termed ‘the obesity paradox’. Our aim was to evaluate the existence of an obesity paradox in patients with ‘ST-elevation acute coronary syndrome (STE-ACS)’ in our population.Methods In this observational study, we included patients presenting with STE-ACS undergoing primary percutaneous coronary intervention (PCI). Body mass index (BMI) ‘(weight (kg)/height (m)2) was calculated and patients with BMI ≥30 kg/m2 were categorised as obese. All the patients were observed during their hospital stay for postprocedure in-hospital morbidity (pump failure, contrast-induced nephropathy, major bleeding, cerebrovascular accident/stroke, access site complications or stent thrombosis) and mortality.Results A total of 1099 patients were included, out of which 78% (857) were men, and mean age was 54.66±10.9 years. The mean BMI was 27.48±4.93 kg/m2 and 23.2% (255) were categorised as obese. The in-hospital morbidity rate was 13.4% (113/844) vs 8.6% (22/255); p=0.042 and in-hospital mortality rate was 1.9% (16/844) vs 4.7% (12/255); p=0.013 for non-obese and obese patients, respectively. On multivariable analysis, obesity showed paradoxical protective effect with adjusted OR of 0.59 (95% CI 0.36 to 0.96, p=0.033) for postprocedure in-hospital morbidity. However, obesity was found to be an independent predictor of in-hospital mortality with an adjusted OR of 3.13 (95% CI 1.37 to 7.15, p=0.007).Conclusion In conclusion, we have found evidence of the obesity paradox in in-hospital morbidity, but not in mortality, after primary PCI of patients with ST-ACS in our population

Acute hyperglycemia, a rabble-rouser or innocent bystander? A prospective analysis of clinical implications of acute hyperglycemia in STE-ACS patients

Abstract Background Acute hyperglycemia is considered an independent prognosticator of both in-hospital and long-term outcomes in patients with acute coronary syndrome (ACS). This study aimed To analyze the incidence of acute hyperglycemia and its impact on the adverse in-hospital outcome in patients with STE-ACS undergoing primary percutaneous coronary intervention (PCI). Methods In this study, we enrolled patients presenting with STE-ACS and undergoing primary PCI at a tertiary care cardiac center. Acute hyperglycemia was defined as random plasma glucose (RBS) > 200 mg/dl at the time of presentation to the emergency room. Results Of the 4470 patients, 78.8% were males, and the mean age was 55.52 ± 11 years. In total, 39.4% (1759) were found to have acute hyperglycemia, and of these, 59% (1037) were already diagnosed with diabetes. Patients with acute hyperglycemia were observed to have a higher incidence of heart failure (8.2% vs. 5.5%; p < 0.001), contrast-induced nephropathy (10.9% vs. 7.4%; p < 0.001), and in-hospital mortality (5.7% vs. 2.5%; p < 0.001). On multivariable analysis, acute hyperglycemia was found to be an independent predictor of mortality with an adjusted odds ratio of 1.81 [1.28–2.55]. Multi-vessel disease (1.73 [1.17–2.56]), pre-procedure left ventricular end-diastolic pressure (LVEDP) (1.02 [1.0-1.03]), and Killip class III/IV (4.55 [3.09–6.71]) were found to be the additional independent predictors of in-hospital mortality. Conclusions Acute hyperglycemia, regardless of diabetic status, is an independent predictor of in-hospital mortality among patients with STE-ACS undergoing primary PCI. Acute hyperglycemia, along with other significant predictors such as multi-vessel involvement, LVEDP, and Killip class III/IV, can be considered for the risk stratification of these patients