Kachoueian, Naser
International Journal of Cardiovascular Practice

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In-hospital and late outcome of rescue versus primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction vakili, hossein; Sadeghi, Roxana; Borjian, Solmaz; Kachoueian, Naser
International Journal of Cardiovascular Practice Vol 1, No 2 (2016)
Publisher : International Journal of Cardiovascular Practice

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (123.19 KB) | DOI: 10.20286/ijcp-010203

Abstract

Introduction: Despite high technical success of rescue Percutaneous Coronary Intervention (PCI) and also its significant impact on left ventricular function, the therapeutic outcome of this PCI technique in comparison with primary PCI for coronary reperfusion has remained uncertain. The present study aimed to conduct a comparative analysis of early and long-term results of patients with ST-Elevation Myocardial Infarction (STEMI), who had undergone primary or rescue PCI.Methods: One hundred and twenty-nine consecutive patients with the diagnosis of STEMI, who underwent primary PCI (n = 107) or rescue PCI (n = 22) from April 2012 to September 2013 were retrospectively included. In addition to early assessment of procedural consequences, the patients were followed-up to assess and compare long-term mortality and major adverse cardiovascular events.Results: Comparing in-hospital consequences of the two rescue PCI and primary PCI procedures showed no significant differences in in-hospital mortality (9.5% vs. 3.7%, P = 0.255), total hospital stay (6.32 ± 2.24 days vs. 6.61 ± 3.43 days, P = 0.720) and also in early procedural complications. Long-term death was found only in 1.9% of patients in the primary group and none of the patients in the rescue group (P = 0.999). There was also no difference in the prevalence of late stent thrombosis between the two groups. However, the in-hospital Left Ventricular Ejection Fraction (LVEF) was lower in the rescue PCI group vs. primary PCI group (36.82 ± 11.19 vs. 43.48 ± 9.14, P = 0.014), but after six months, LVEF was similar between the two groups (41.05 ± 9.57 vs. 44.29 ± 10.35, P = 0.082).Conclusions: Our study showed no difference in early and late procedural outcome between the primary and rescue PCI techniques in STEMI patients, but LVEF had better improvement in the rescue PCI group.
One- and Six-month Outcomes of Patients with Non-ST Elevation Myocardial Infarction Vakili, Hossein; Sadeghi, Roxana; Toofaninejad, Neda; Akbari, Tooba; Kachoueian, Naser
International Journal of Cardiovascular Practice Vol 1, No 3 (2016)
Publisher : International Journal of Cardiovascular Practice

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (173.054 KB) | DOI: 10.21859/ijcp-010303

Abstract

Introduction: Use of risk scoring systems in patients with acute coronary syndrome helps with summarizing important prognostic data of the disease and facilitates calculating confidence limits and comparing survival rates between different treatments. In the present study, the researchers first aimed at assessing mid-term outcome of patients with non-ST elevation myocardial infarction (NSTEMI), and then determining main predictors of this outcome to improve definitive criteria for designing a risk scoring system in the population.Methods: In a prospective cohort study, 124 patients with NSTEMI, diagnosed according to ACC/AHA guidelines and hospitalized in an academic hospital in 2013, were consecutively assessed. Baseline characteristics were collected via interviewing, physical examination, and reviewing the recorded files. All the patients were followed for one and six months to assess mid-term outcomes regarding mortality and major adverse cardiac events (MACE). MACE is defined as the occurrence of at least one of the events of death, myocardial infarction, repeated revascularization, or re-hospitalization.Results: One-month death occurred in 3.2%, re-hospitalization in 4.0%, and myocardial infarction in none of the patients. In addition, regarding the six-month outcomes status, mortality rate was determined in 6.4%, re-hospitalization in 22.6%, and myocardial infarction in 4.8% of patients. Hence, one- and six-month MACE rates were 7.3% and 27.4%, respectively. Furthermore, three- and six-month survival rates were estimated to be 96.8% and 93.6%, respectively. According to the Cox-proportion hazard modeling, only reduced left ventricular ejection fraction (LVEF) (HR = 0.909, P = 0.017), history of chronic kidney injury (HR = 8.884, P = 0.005), and Inotrope use (HR = 35.759, P = 0.012) could predict the six-month MACE. None of the other indexes including general coronary risk factors, echocardiography parameters, and level of cardiac enzymes could predict mortality rate.Conclusions: Patients with NSTEMI may face high six-month MACE which can be predicted by low LVEF, history of renal injury and use of inotrope. Therefore, to define risk stratification system, these indicators should be considered as well.