INCIDENCE AND PREDICTORS OF RESTENOSIS IN PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTIONS IN PAKISTAN
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Keywords
Restenosis, Percutaneous Coronary Intervention, Diabetes, Hypertension, Drug-Eluting Stents, Bare-Metal Stents, Pakistan
Abstract
Background Restenosis, characterized by the re-narrowing of a coronary artery following percutaneous coronary intervention (PCI), remains a significant clinical challenge. Despite advances in interventional cardiology, restenosis continues to compromise long-term outcomes and necessitate repeat revascularization procedures.
Objective This observational cohort study investigates the incidence and predictors of restenosis in Pakistani patients undergoing primary PCI at the Lady Reading Hospital in Peshawar.
Methods Data from 303 patients who underwent primary PCI between January 2022 and December 2023 at the Lady Reading Hospital in Peshawar were retrospectively analyzed. Baseline characteristics, including age, sex, comorbidities, and procedural details, were collected. The primary outcome was the incidence of restenosis, defined as greater than 50% luminal narrowing of the treated segment on follow-up angiography. Secondary outcomes included analysis of predictors such as patient demographics, comorbid conditions, and procedural characteristics.
Results The study found an overall restenosis incidence of 17.2%. Multivariate logistic regression identified diabetes (OR: 2.34, 95% CI: 1.26-4.36, p=0.007), hypertension (OR: 1.89, 95% CI: 1.05-3.41, p=0.034), and stent length (mean: 28.5 mm, SD: 6.4 mm, p=0.021) as significant predictors of restenosis. Additionally, drug-eluting stents (DES) were associated with a lower incidence of restenosis (13.5%) compared to bare-metal stents (BMS) (23.8%). The study also found higher restenosis rates in male patients (19.3%) compared to female patients (12.5%) and in patients aged ≥60 years (20.4%) compared to those aged <60 years (14.1%).
Conclusion This study highlights the significant predictors of restenosis in Pakistani patients undergoing primary PCI. Diabetes, hypertension, and longer stent length are associated with increased restenosis risk, while DES appears more effective in reducing restenosis compared to BMS. These findings suggest the need for tailored treatment strategies to improve patient outcomes.
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Dr Hafiz Adil Bilal
Fellow Interventional Cardiology, Lady Reading Hospital, Peshawar, Pakistan
Dr Shahzeb Khan
Resident Cardiologist, Lady Reading Hospital, Peshawar, Pakistan
Dr Shahbaz Ali Shaikh
Associate Professor, National Institute of Cardiovascular Diseases Karachi, Pakistan
Dr. Haseeb Ullah
Resident Cardiologist, Lady Reading Hospital, Peshawar, Pakistan
Fahad Raja Khan
Fellow Interventional Cardiology, Peshawar Institute of Cardiology, Pakistan
Dr Waseem Sajjad
Fellow Interventional Cardiology, Lady Reading Hospital, Peshawar, Pakistan