The frequency of adverse events of primary percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction at ≥ 5 TIMI score in public sector hospital 

Suhail Ahmed¹, Nasir Ali², Tahir Hussain³, Tarique Ahmed^4*, Jagdesh Kumar⁵, Shahzad⁶

1. Dr. Suhail Ahmed, Post fellow Cardiology.

2. Dr. Nasir Ali, Interventional cardiology fellow NICVD karachi.

3. Tahir Hussain, Vice-principal, Karachi institute of health science.

4. Dr. Tarique Ahmed, post fellow NICVD Karachi.

5. Dr. Jagdesh kumar, Memon medical institute hospital karachi, Consultant Interventional Cardiologist, Karachi.

6. Dr. SHAHZAD, Post fellow NICVD.

Corresponding Author: Dr. Suhail Ahmed, Post fellow Cardiology.

Copy Right: © 2021 Dr. Suhail Ahmed. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: July 01, 2021

Published date: July 15, 2021

Abstract

1.1 Background: The Thrombolysis in Myocardial Infarction, TIMI risk score for STEMI is a simple arithmetic score that proved to be useful in patients treated with primary PCI. To determine the treatment strategies for obstructed coronary blood flow and myocardial system, it is important to identify intervention strategies. As to treat primary PCI,

1.2 Objective: The report focuses on the adverse events due to PCI among patients having STEMI ≥ 5 TIMI scores in public sector hospitals. The overall objective would be analyzing the situation and providing an adequate solution to cater to the need of STEMI patients and to reduce the mortality rate.

1.3 Study Design: Case Series

1.4 Setting: Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi

1.5 Duration: 28th October 2016 to 27th April 2017

1.6 Material and Methods: A total of 150 patients with ≥ 5 TIMI scores were included. The arterial sheath was passed through the femoral route. TIMI scores were calculated. The adverse outcome was observed and recorded. Descriptive statistics were calculated. Stratification was done and a chi-square test was applied. P-value ≤0.05 was considered significant.

1.7 Results: There were 122 male and 28 female patients. The mean age was 58.41±13.51 years. The mean BMI was 29.71±3.67 kg/m2. The mean TIMI score was 7.24±2.42. There were 24.7% smokers, 42.7% hypertensive, 16.7% diabetic, and 8% anemic patients. Death was observed in 14.7% of cases, heart failure in 18.7% cases, cardiogenic shock in 12% cases, and ventricular arrhythmias in 16% cases.

1.8 Conclusion: According to the TIMI score, there high risk associated with those having STEMI if not taken into account care and can also lead to additional problems like heart failure and bleeding.

2.Introduction:

Cardiovascular disease (CVD) is among the most deadly disease-causing mortality rate to increase and almost one-third of the population have been suffering from it.[1] Substantial advance in the treatment of acute myocardial infarction (AMI) is the intervention in order to provide basic care towards STEMI patients while involving myocardial research with the help of randomized control trials RCTs. [2,3]

The report structures towards designing strategies in which patients will be analyzed in order to investigate proper intervention in order to create proper strategies for mitigating the mortality rate regarding STEMI. [4] Despite its challenges, it will be defined toward randomized control trial RCTs which will be reported 6-9% in which 30-35 days whereas the report also covers thrombolytic therapy within 6 hours. [5,6]

Often, the report also discussed alternative options and certain therapies which will provide improvement an agent treatment plan to mitigate the risk associated with the disease. It is recommended to provide special attention to additional factors which can increase the risk and associated mortality rate. The report will also investigate the early invasive which will be therapeutic and increase the survival chance related to the disease. For Acute Coronary Syndromes (ACS) the related intervention will also be explained and analyzed. [7]

Whereas those patients who receive therapies in order to deal with STEMI will be examined and analyzed. The risks in terms of long-term and short-term impacts can also be seen. [8-10]

After analyzing the STEMI intervention, it can be seen that there are a lot of early interventions designed to overcome the mortality rate and various therapies have been successful in implementing positive outcomes. Hospitals staff and nurse management is a crucial factor to combat against disease with the help of clinical and expert resources. [11]

A study by Reddy et al stated the fact that the success rate of angioplasty is much more and has positive outcomes with fewer chances of reoccurrence of ischemic. [12] Study by Ranjan et al provided insight into the development in the field of STEMI and its prevention. The option of angioplasty reveals a success rate of 98% along with transradial which is in demand in the field. [13] Another study conducted by Ellen C et all focuses on PCI which restoring angiographically among the normal flow, [14,15] whereas fibrinolytic therapy does so in only 50 to 60% of such patients. [14]

The procedural success was 97%.[16] Patients classified as high risk (TIMI ≥ 5) had a higher incidence of adverse events than the low-risk group: mortality 14.8% vs.2.1%, (p=0.0001); heart failure 15.3% vs.4.1%, (p=0.0001); development of cardiogenic shock 10.9% vs.1.5%, (p=0.0001); ventricular arrhythmias 14.8% vs. 5.9%.[17]

While analyzing TIMI the risk score for STEMI would be simple arithmetic in order to provide a further description of mortality. In this era of technology, some evident interventions in the field of STEMI range from pharmacologic to devise therapy. These recent development aids in improving the lifestyle of STEMI patients. [18]

The TIMI risk score for STEMI preferred to be used for presenting STEMI while placing it with the bedside of patients. [19] For each patient, the Score calculated in such a way as to justify the (range, 0–14).[20] CKD is considered to be an independent risk factor for coronary artery disease (CAD). [21]

The South Asian countries of India, Pakistan, Bangladesh, Sri Lanka, and Nepal make about a quarter of the world’s population and this region has the highest rate of cardiovascular diseases compared with any other region globally and is, therefore, the leading cause of death in the Indo-Pak subcontinent. [22] the impact of CVD and PCI tends to more on people living a life of low and middle-income class whereas it is very common among developing countries where there are health-related risks like obesity and tobacco usage16 and also these are the leading cause of death for both men and women all over the world. [23,24]

However, knowledge of the adverse events is primarily derived from developed countries thus knowledge of the importance of the adverse events in the local population groups should be considered because of the different body habitus, environment and dietary habits, moreover, the TIMI risk score is the easiest, bedside and accessible way for risk stratification of patients after acute MI going for Primary PCI. Patients with a TIMI score >5 are more prone to develop complications. As there is limited local data available, therefore my study will provide the correct magnitude of complications in our local population and it will also identify more common adverse events among these complications in our local population and it will be helpful for the healthcare provider to evaluate and identify the high-risk patients and minimize and prevent the complications during and after the procedure. In case of complication, prompt action will be taken, and manage them accordingly, which will further help in decreasing morbidity and mortality. Thus to determine the frequency of adverse events of primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction at ≥ 5 TIMI score in public sector hospitals makes strong rationale to conduct this research in a large number of patients. 

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