INFLUENCE OF COMORBID CONDITIONS ON THE SUCCESS RATES OF LEFT MAIN CORONARY ARTERY PCI IN PAKISTANI PATIENTS
Main Article Content
Keywords
Percutaneous coronary intervention, left main coronary artery, diabetes, chronic kidney disease, major adverse cardiac events, Pakistan, cardiovascular outcomes.
Abstract
Background: Percutaneous coronary intervention (PCI) is a crucial treatment for patients with significant left main coronary artery (LMCA) disease, which is associated with high morbidity and mortality. The presence of comorbid conditions such as diabetes and chronic kidney disease (CKD) can influence the success rates and outcomes of PCI.
Objective: This study aimed to evaluate the influence of comorbid conditions on the success rates of left main coronary artery PCI in Pakistani patients.
Methods: A quasi-experimental design was employed at Lady Reading Hospital, Peshawar, from January to June 2023. A total of 250 patients diagnosed with significant LMCA disease and scheduled for elective PCI were included. Patients were categorized based on the presence of diabetes and CKD. Data on baseline characteristics, PCI success rates, incidence of major adverse cardiac events (MACE) within 30 days, and length of hospital stay were collected using standardized forms. Statistical analysis was performed using SPSS version 25.0, with comparisons made using chi-square tests for categorical variables and ANOVA or Kruskal-Wallis tests for continuous variables.
Results: The mean age of participants was 62.5 years (SD ± 10.8), with 64% males and 36% females. The overall success rate of PCI was 85%. Success rates were significantly lower in patients with diabetes (78%) and CKD (75%) compared to those without these conditions (90% and 88%, respectively; p < 0.05). The incidence of MACE was higher in patients with diabetes (22%) and CKD (25%) compared to non-diabetic (10%) and non-CKD (12%) patients (p < 0.05). The mean hospital stay was longer for patients with diabetes (7.2 days, SD ± 2.1) and CKD (7.5 days, SD ± 2.3) compared to non-diabetic (5.6 days, SD ± 1.8) and non-CKD (5.8 days, SD ± 1.9) patients.
Conclusion: Comorbid conditions such as diabetes and CKD significantly impact the success rates and outcomes of left main coronary artery PCI in Pakistani patients. These findings underscore the need for targeted interventions and management strategies to improve clinical outcomes for high-risk patients.
Objective: This study aimed to evaluate the influence of comorbid conditions on the success rates of left main coronary artery PCI in Pakistani patients.
Methods: A quasi-experimental design was employed at Lady Reading Hospital, Peshawar, from January to June 2023. A total of 250 patients diagnosed with significant LMCA disease and scheduled for elective PCI were included. Patients were categorized based on the presence of diabetes and CKD. Data on baseline characteristics, PCI success rates, incidence of major adverse cardiac events (MACE) within 30 days, and length of hospital stay were collected using standardized forms. Statistical analysis was performed using SPSS version 25.0, with comparisons made using chi-square tests for categorical variables and ANOVA or Kruskal-Wallis tests for continuous variables.
Results: The mean age of participants was 62.5 years (SD ± 10.8), with 64% males and 36% females. The overall success rate of PCI was 85%. Success rates were significantly lower in patients with diabetes (78%) and CKD (75%) compared to those without these conditions (90% and 88%, respectively; p < 0.05). The incidence of MACE was higher in patients with diabetes (22%) and CKD (25%) compared to non-diabetic (10%) and non-CKD (12%) patients (p < 0.05). The mean hospital stay was longer for patients with diabetes (7.2 days, SD ± 2.1) and CKD (7.5 days, SD ± 2.3) compared to non-diabetic (5.6 days, SD ± 1.8) and non-CKD (5.8 days, SD ± 1.9) patients.
Conclusion: Comorbid conditions such as diabetes and CKD significantly impact the success rates and outcomes of left main coronary artery PCI in Pakistani patients. These findings underscore the need for targeted interventions and management strategies to improve clinical outcomes for high-risk patients.
References
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2. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomized clinical SYNTAX trial. Lancet. 2013;381(9867):629-638.
3. Marso SP, Hiatt WR. Peripheral arterial disease in patients with diabetes. J Am Coll Cardiol. 2006;47(5):921-929.
4. Herzog CA, Littrell K, Arko C, et al. Clinical characteristics and outcomes of coronary artery bypass grafting patients with chronic kidney disease. J Am Soc Nephrol. 2004;15(1):285-293.
5. Ahmad K, Jafar TH, Siddiqui MS. Prevalence and determinants of coronary artery disease in a rural population of Pakistan. J Pak Med Assoc. 2005;55(9):364-368.
6. Yusuf S, Reddy S, Ounpuu S, et al. Global burden of cardiovascular diseases: Part I: General considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104(22):2746-2753.
7. van Domburg RT, Lemos PA, Takkenberg JJ, et al. Long-term outcomes after coronary stenting: a 10-year single-centre follow-up analysis. J Am Coll Cardiol. 2006;47(7):1350-1355.
8. Kastrati A, Mehilli J, Dirschinger J, et al. Restenosis after coronary placement of various stent types. Am J Cardiol. 2001;87(1):34-39.
9. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005;293(17):2126-2130.
10. Akiyama T, Moussa I, Reimers B, et al. Angiographic and clinical outcome following coronary stenting of bifurcation lesions. J Am Coll Cardiol. 2000;35(5):1145-1151.
11. Bhatt DL, Marso SP, Hirsch AT, et al. Amplified benefit of clopidogrel versus aspirin in patients with diabetes mellitus. Am J Cardiol. 2002;90(6):625-628.
12. Reddan DN, Szczech LA, Tuttle RH, et al. Chronic kidney disease, mortality, and treatment strategies among patients with clinically significant coronary artery disease. J Am Soc Nephrol. 2003;14(9):2373-2380.
13. Singh M, Rihal CS, Lennon RJ, et al. Influence of diabetes on long-term outcome after percutaneous coronary intervention. J Am Coll Cardiol. 2002;40(3):418-423.
14. Charytan D, Kuntz RE. The exclusion of patients with chronic kidney disease from clinical trials in coronary artery disease. Kidney Int. 2006;70(11):2021-2030.
15. Azhar M, Yousuf A, Habib S, et al. Impact of diabetes mellitus on long-term outcomes in patients with coronary artery disease treated with percutaneous coronary intervention. J Coll Physicians Surg Pak. 2010;20(3):168-172.
16. Stefanini GG, Holmes DR Jr. Drug-eluting coronary-artery stents. N Engl J Med. 2013;368(3):254-265.
17. Bangalore S, Kumar S, Fusaro M, et al. Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials. Circulation. 2012;125(23):2873-2891.
18. Mehilli J, Kastrati A, Dirschinger J, et al. Differences in prognostic factors and outcomes between women and men undergoing coronary artery stenting. JAMA. 2000;284(14):1799-1805.
19. Singh M, Rihal CS, Lennon RJ, et al. Influence of chronic kidney disease in patients undergoing percutaneous coronary intervention: 1-year outcomes. Am J Cardiol. 2004;94(11):1460-1463.
2. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomized clinical SYNTAX trial. Lancet. 2013;381(9867):629-638.
3. Marso SP, Hiatt WR. Peripheral arterial disease in patients with diabetes. J Am Coll Cardiol. 2006;47(5):921-929.
4. Herzog CA, Littrell K, Arko C, et al. Clinical characteristics and outcomes of coronary artery bypass grafting patients with chronic kidney disease. J Am Soc Nephrol. 2004;15(1):285-293.
5. Ahmad K, Jafar TH, Siddiqui MS. Prevalence and determinants of coronary artery disease in a rural population of Pakistan. J Pak Med Assoc. 2005;55(9):364-368.
6. Yusuf S, Reddy S, Ounpuu S, et al. Global burden of cardiovascular diseases: Part I: General considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104(22):2746-2753.
7. van Domburg RT, Lemos PA, Takkenberg JJ, et al. Long-term outcomes after coronary stenting: a 10-year single-centre follow-up analysis. J Am Coll Cardiol. 2006;47(7):1350-1355.
8. Kastrati A, Mehilli J, Dirschinger J, et al. Restenosis after coronary placement of various stent types. Am J Cardiol. 2001;87(1):34-39.
9. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005;293(17):2126-2130.
10. Akiyama T, Moussa I, Reimers B, et al. Angiographic and clinical outcome following coronary stenting of bifurcation lesions. J Am Coll Cardiol. 2000;35(5):1145-1151.
11. Bhatt DL, Marso SP, Hirsch AT, et al. Amplified benefit of clopidogrel versus aspirin in patients with diabetes mellitus. Am J Cardiol. 2002;90(6):625-628.
12. Reddan DN, Szczech LA, Tuttle RH, et al. Chronic kidney disease, mortality, and treatment strategies among patients with clinically significant coronary artery disease. J Am Soc Nephrol. 2003;14(9):2373-2380.
13. Singh M, Rihal CS, Lennon RJ, et al. Influence of diabetes on long-term outcome after percutaneous coronary intervention. J Am Coll Cardiol. 2002;40(3):418-423.
14. Charytan D, Kuntz RE. The exclusion of patients with chronic kidney disease from clinical trials in coronary artery disease. Kidney Int. 2006;70(11):2021-2030.
15. Azhar M, Yousuf A, Habib S, et al. Impact of diabetes mellitus on long-term outcomes in patients with coronary artery disease treated with percutaneous coronary intervention. J Coll Physicians Surg Pak. 2010;20(3):168-172.
16. Stefanini GG, Holmes DR Jr. Drug-eluting coronary-artery stents. N Engl J Med. 2013;368(3):254-265.
17. Bangalore S, Kumar S, Fusaro M, et al. Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials. Circulation. 2012;125(23):2873-2891.
18. Mehilli J, Kastrati A, Dirschinger J, et al. Differences in prognostic factors and outcomes between women and men undergoing coronary artery stenting. JAMA. 2000;284(14):1799-1805.
19. Singh M, Rihal CS, Lennon RJ, et al. Influence of chronic kidney disease in patients undergoing percutaneous coronary intervention: 1-year outcomes. Am J Cardiol. 2004;94(11):1460-1463.
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Published
Jun 25, 2024
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How to Cite
Dr Rafi Ullah, Dr Honey Raj Vishno, Dr Syed Muzammil Shah, Dr Muhammad Abdur Rauf, Dr Fahad Raja Khan, & Dr Ejaz Ul Haq. (2024). INFLUENCE OF COMORBID CONDITIONS ON THE SUCCESS RATES OF LEFT MAIN CORONARY ARTERY PCI IN PAKISTANI PATIENTS. Journal of Population Therapeutics and Clinical Pharmacology, 31(6), 2800-2805. https://doi.org/10.53555/jptcp.v31i6.7102
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Author Biographies
Dr Rafi Ullah
Cardiologist, Kuwait Teaching Hospital Peshawar, Pakistan
Dr Honey Raj Vishno
Cardiology Resident, NICVD, Karachi, Pakistan
Dr Syed Muzammil Shah
Medical Officer, Kuwait Teaching Hospital, Pakistan
Dr Muhammad Abdur Rauf
Assistant Professor of Cardiology, Kuwait Teaching Hospital/Peshawar Medical College Peshawar, Pakistan
Dr Fahad Raja Khan
Fellow Interventional Cardiology, Peshawar Institute of Cardiology, Pakistan
Dr Ejaz Ul Haq
Fellow Interventional Cardiology, NICVD Karachi, Pakistan
How to Cite
Dr Rafi Ullah, Dr Honey Raj Vishno, Dr Syed Muzammil Shah, Dr Muhammad Abdur Rauf, Dr Fahad Raja Khan, & Dr Ejaz Ul Haq. (2024). INFLUENCE OF COMORBID CONDITIONS ON THE SUCCESS RATES OF LEFT MAIN CORONARY ARTERY PCI IN PAKISTANI PATIENTS. Journal of Population Therapeutics and Clinical Pharmacology, 31(6), 2800-2805. https://doi.org/10.53555/jptcp.v31i6.7102