CLINICAL OUTCOMES OF HIGH-RISK PCI PROCEDURES IN PAKISTANI PATIENTS: A MULTICENTER STUDY
Main Article Content
Keywords
Percutaneous coronary intervention, coronary artery disease, high-risk PCI, left ventricular ejection fraction, major adverse cardiac events, Pakistan, cardiac function, exercise tolerance, angina reduction.
Abstract
Background: Percutaneous coronary intervention (PCI) treats coronary artery disease (CAD). It is crucial for high-risk patients with left main disease, multi-vessel disease, or low left ventricular ejection fraction (LVEF). High-risk PCI is ideal for those unsuitable for coronary artery bypass grafting (CABG) due to age or other issues.
Objective : This study assesses high-risk PCI outcomes in Pakistani patients across several centers.
Methods: This multicenter observational study was conducted from January to June 2023 at Hayatabad Medical Complex, Lady Reading Hospital, and Peshawar Institute of Cardiology. The Institutional Review Board of Hayatabad Medical Complex approved the study (IRB number: HMC-IRB-2023-007). It included 303 patients with severe CAD. Data on patient characteristics, PCI success rates, and major adverse cardiac events (MACE) within 30 days were collected. Secondary outcomes included improved LVEF, exercise tolerance, and reduced angina symptoms. Analysis was performed using SPSS version 25.0.
Results: The mean age was 62.1 years (SD ± 10.7). Males comprised 65%, and females 35%. The PCI success rate was 89%. MACE occurred in 15%, with 5% experiencing myocardial infarction, 3% stent thrombosis, and 7% cardiac death. The mean LVEF increased from 42% (SD ± 8) to 50% (SD ± 7) post-procedure (p < 0.001). The six-minute walk test distance rose from 320 meters (SD ± 55) to 370 meters (SD ± 50) (p < 0.01). Angina episodes per week decreased from 4.2 (SD ± 1.5) to 1.7 (SD ± 0.9) (p < 0.001).
Conclusion: High-risk PCI improves cardiac function, exercise tolerance, and reduces angina in Pakistani patients. This supports PCI as an effective treatment for severe CAD in high-risk patients across multiple centers in Pakistan.
Objective : This study assesses high-risk PCI outcomes in Pakistani patients across several centers.
Methods: This multicenter observational study was conducted from January to June 2023 at Hayatabad Medical Complex, Lady Reading Hospital, and Peshawar Institute of Cardiology. The Institutional Review Board of Hayatabad Medical Complex approved the study (IRB number: HMC-IRB-2023-007). It included 303 patients with severe CAD. Data on patient characteristics, PCI success rates, and major adverse cardiac events (MACE) within 30 days were collected. Secondary outcomes included improved LVEF, exercise tolerance, and reduced angina symptoms. Analysis was performed using SPSS version 25.0.
Results: The mean age was 62.1 years (SD ± 10.7). Males comprised 65%, and females 35%. The PCI success rate was 89%. MACE occurred in 15%, with 5% experiencing myocardial infarction, 3% stent thrombosis, and 7% cardiac death. The mean LVEF increased from 42% (SD ± 8) to 50% (SD ± 7) post-procedure (p < 0.001). The six-minute walk test distance rose from 320 meters (SD ± 55) to 370 meters (SD ± 50) (p < 0.01). Angina episodes per week decreased from 4.2 (SD ± 1.5) to 1.7 (SD ± 0.9) (p < 0.001).
Conclusion: High-risk PCI improves cardiac function, exercise tolerance, and reduces angina in Pakistani patients. This supports PCI as an effective treatment for severe CAD in high-risk patients across multiple centers in Pakistan.
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. Giustino G, Chieffo A, Palmerini T, et al. Efficacy and safety of dual antiplatelet therapy after complex PCI. J Am Coll Cardiol. 2016;68(17):1851-1864.
4. Jafar TH, Jafary FH, Jessani S, et al. Heart disease epidemic in Pakistan: women and men at equal risk. Am Heart J. 2005;150(2):221-226.
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. Hakeem A, Garg N. The burden of coronary heart disease in South Asians. Texas Heart Institute Journal. 2011;38(5):527-529.
8. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. J Am Coll Cardiol. 2011;58(24).
9. Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123(23):2736-2747.
10. Cohen DJ, Van Hout B, Serruys PW, et al. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery. N Engl J Med. 2011;364(11):1016-1026.
11. 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.
12. Park SJ, Ahn JM, Kim YH, et al. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med. 2015;372(13):1204-1212.
13. Johnson NP, Tóth GG, Lai D, et al. Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes. J Am Coll Cardiol. 2014;64(16):1641-1654.
14. Maddox TM, Stanislawski MA, Grunwald GK, et al. Nonobstructive coronary artery disease and risk of myocardial infarction. JAMA. 2014;312(17):1754-1763.
15. Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2014;64(18):1929-1949.
16. Navarese EP, Kozinski M, Andreotti F, et al. Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomized controlled trials. BMJ. 2015;350.
17. Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007;115(17):2344-2351.
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. Giustino G, Chieffo A, Palmerini T, et al. Efficacy and safety of dual antiplatelet therapy after complex PCI. J Am Coll Cardiol. 2016;68(17):1851-1864.
4. Jafar TH, Jafary FH, Jessani S, et al. Heart disease epidemic in Pakistan: women and men at equal risk. Am Heart J. 2005;150(2):221-226.
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. Hakeem A, Garg N. The burden of coronary heart disease in South Asians. Texas Heart Institute Journal. 2011;38(5):527-529.
8. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. J Am Coll Cardiol. 2011;58(24).
9. Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123(23):2736-2747.
10. Cohen DJ, Van Hout B, Serruys PW, et al. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery. N Engl J Med. 2011;364(11):1016-1026.
11. 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.
12. Park SJ, Ahn JM, Kim YH, et al. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med. 2015;372(13):1204-1212.
13. Johnson NP, Tóth GG, Lai D, et al. Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes. J Am Coll Cardiol. 2014;64(16):1641-1654.
14. Maddox TM, Stanislawski MA, Grunwald GK, et al. Nonobstructive coronary artery disease and risk of myocardial infarction. JAMA. 2014;312(17):1754-1763.
15. Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2014;64(18):1929-1949.
16. Navarese EP, Kozinski M, Andreotti F, et al. Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomized controlled trials. BMJ. 2015;350.
17. Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007;115(17):2344-2351.
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Published
Jun 25, 2024
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How to Cite
Dr Irum Hussain, Dr Sher Ali Khan, Dr Kamran Aslam, & Dr Fahad Raja Khan. (2024). CLINICAL OUTCOMES OF HIGH-RISK PCI PROCEDURES IN PAKISTANI PATIENTS: A MULTICENTER STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 31(6), 2995-3000. https://doi.org/10.53555/jptcp.v31i6.7179
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Author Biographies
Dr Irum Hussain
Fellow Cardiology Hayatabad Medical Complex, Peshawar, Pakistan
Dr Sher Ali Khan
Postgraduate Resident Cardiology Lady Reading Hospital Peshawar, Pakistan
Dr Kamran Aslam
Fellow Interventional Cardiology Peshawar Institute of Cardiology, Pakistan
Dr Fahad Raja Khan
Fellow Interventional Cardiology Peshawar Institute of Cardiology, Pakistan
How to Cite
Dr Irum Hussain, Dr Sher Ali Khan, Dr Kamran Aslam, & Dr Fahad Raja Khan. (2024). CLINICAL OUTCOMES OF HIGH-RISK PCI PROCEDURES IN PAKISTANI PATIENTS: A MULTICENTER STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 31(6), 2995-3000. https://doi.org/10.53555/jptcp.v31i6.7179