Post PCI with stenting Follow Up in Women for 7 Years in Public Sector Tertiary Care Cardiac Unit. Retrospective Study
Abstract
Khalida Soomro, Zaman baloch
Introduction: Despite of the fact that there is continual improvement in diagnostic and therapeutic procedures in catherization Lab introduction of better catheter techniques and new-generation stents and with the acquisition of knowledge from largescale clinical trials Still women appear to have a higher in-hospital mortality after PCI with stenting and during long term follow up specially in developing countries of South Asia the, Reason could be multi-factorial in women.
The objectives: The goals of treatment in PCI with stenting in Women is to improve quality of life, to prevent CHD from becoming symptomatic, prevent myocardial infarction, cardiac death and heart failure, the approaches to achieve these goals at the societal or individual level in this regards differ among various countries, the data that have been published are often limited due to the relatively small number of western women. It is important to collect data in under developed countries on outcomes of long term follow up of women with AMI after PCI with stenting to change the global perception of treatment of women with myocardial infarction.
Material and Method: Out of 3300 patients, underwent successful PCI with stenting during 2010 to 2016 in Cath Lab of cardiology department of Dow University of Health and Sciences Karachi Pakistan , 577 patients with Sciences Karachi Pakistan, 577 patients with Myocardial infarction within 7 days were included in study and they constitute the present followup population. Additional data regarding noncardiac comorbid diseases and Risk factors were obtained along with crucial aspects of women’s health, such as menopausal status, use of hormonal contraceptives, Follow-up was planned after 1 month and then with annualy for 7 years. The primary end point of study were the long-term rate of major adverse cardiac events (i.e. death, Infarction, and repeat revascularization). The secondary end points were the individual components of the major adverse cardiac events and stent thrombosis.
Result: This observational study was conducted by reviewing the record of cases performed and getting information on follow up visits of patients for 7 years from June 2010 to June 2016, out of total 3300 procedure 577 patients were included in the study who underwent PCI with stenting with in the 7 day of Myocardial infarction consisting of 346 patient from urban and 237 people from Rural areas of Sindh Balochistan Provinice of Pakistan Revascularization with stenting was performed in 313 patients 40-50 years of age followed by 219 patients 56-70 years of age in comparison to 23 in older group > 70 years and 22 in younger age < 40 years ,In 528 (91.5%)patients PCI with BMS, in 28 (4.8%)patients DES alone and in 21 (3.6%)patients with BMS and DES performed The odds of short-term mortality were significantly higher among older post - menopausal group compared to premenopausal patients <55 . I3 patients (5 patients during hospitalization) and 8 patients died within 30 days after PCI. Total 57((9.8%) patient died during7 years follow up, 31 (58.5%) cases due to comorbid conditions, and remaining 27 patients death was due to myocardial infarction in 13 (39.4%). Arrhythmias in 5 (9.4%) and worsening of heart Failure in 8 (42.1%) elderly patients. Patient had complete Closure of Target Vessel, 28 (4.8%) had Re PCI on 7 years follow up and CABG was performed in 13 (2.2%). Patients main reason could be noncompliance of therapy in 71 (12.3%) in patients.
Conclusion: Ideally a Women patient who has undergone coronary stent implantation should be cared for by the primary cardiologist who by working closely together for long term outcomes in different developing countries of South Asia to collect the data which will change the perception about the treatment of Myocardial infarction in women globally and help in making guidelines.