OUTCOME OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION WITH EARLY AND LATE ST RESOLUTION - EARLIER IS BETTER!

Abstract

Objective: To compare the outcome of Primary PCI in patients presenting withearly ST resolution versus those presenting late ST resolution after the procedure.

Methodology: This observational prospective study was conducted in theCatheterization Laboratory of a Tertiary Care Cardiovascular Centre of Pakistan.Those patients who under went primary PCI were enrolled. All patients were pretreated with Aspirin 300 mg, and Clopidogrel 600mg. Platelet glycoprotein IIb IIIainhibitor was given in the Catheterization Laboratory before the commencementof procedure. Primary PCI was done in a standard fashion. Procedural details,angiographic and electrocardiographic signs were recorded after PCI and clinicalfollow up was documented up to 1 year.

Results: A total of 150 consecutive patients underwent primary PCI. 112 patientsshowed ST resolution within 60 minutes while 38 patients showed ST resolutionafter 60 minutes. Patients with early ST resolution showed significant proceduralsuccess (100 % vs. 94.7 %; P=0.014), and stable follow up at 30 days (92 % vs.50 %; P= <0.001) and one year (88.3 % vs. 60.6 %; P=< 0.001). Mortality at30 days was significantly lower (0.9% vs. 7.9 %; P=0.019) in patients with earlyST resolution while coronary artery bypass surgery was also significantly lowerat 30 days (1.7 % vs. 15.8 %; P=0.001) and one year (2.7 % vs. 15.8 %;P=0.004). Patients with late ST resolution were significantly aged (54.5±8.1 vs.50.4±12.9; P=0.023), more diabetic (39.5 % vs. 19.6 %; P=0.014), havinglonger (>120 minutes) chest pain to ER time (34.2 % vs. 17.9%; P=0.03), andhaving diffusely diseased vessels (73.7% vs. 52.7%; P=0.023). Three vesseldisease was also more frequently seen in patients with late ST resolution (36.9%vs. 17.9%; P=0.015).

Conclusion: Outcome of patients showing early ST resolution is significantlybetter than those showing late ST resolution. Elderly, diabetes, longer chest painto ER time and diffuse three vessel disease are associated with late ST resolution.