Correlation Between Ischemia Time and Left Ventricular Failure After Primary Percutaneous Coronary Intervention in
Sher Wali Khan1, Ayesha Fayyaz1, Ikram Ullah1
1Cardiology, Lady Reading Hospital - Medical Teaching Institute, Peshawar, PAK.
Insights
Prolonged ischemia time and factors like advanced age, diabetes, and hypertension increase the risk of left ventricular failure (LVF) after primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). Prompt treatment is crucial for better outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Research
Background:
- Primary percutaneous coronary intervention (PPCI) is a critical treatment for ST-elevation myocardial infarction (STEMI).
- Ischemia time is a significant determinant of patient outcomes, particularly the risk of left ventricular failure (LVF).
Purpose of the Study:
- To investigate the impact of ischemia duration on severe left ventricular systolic dysfunction in STEMI patients undergoing PPCI.
- To identify other variables associated with poor left ventricular function post-PPCI.
Main Methods:
- Prospective cohort study of 236 STEMI patients (aged 18-70) treated with PPCI within 12 hours of symptom onset.
- Exclusion criteria included coronary dissection, late presenters (>12 hours), no stenting, prior interventions, pre-existing systolic heart failure, arrhythmias, or previous acute coronary syndrome.
- Statistical analysis involved multivariate regression, Pearson's correlation, and descriptive statistics to identify predictors of severe left ventricular dysfunction.
Main Results:
- Significant predictors of severe left ventricular systolic dysfunction included prolonged ischemia duration (OR 1.45, p<0.001), advanced age (OR 1.02, p=0.015), diabetes (OR 2.34, p=0.001), hypertension (OR 1.76, p=0.031), and prior cardiac events (OR 2.89, p=0.002).
- Left ventricular ejection fraction (LVEF) was <30% in 9.32% and 30-40% in 24.58% of patients.
- Overall, 20.33% of patients experienced LVF during the six-month follow-up.
Conclusions:
- Prolonged ischemia, older age, diabetes, hypertension, and prior cardiac events are associated with an increased risk of LVF after PPCI in STEMI patients.
- Timely intervention and comprehensive management are essential for improving outcomes in high-risk STEMI patients.
- Early identification of risk factors can guide therapeutic strategies to mitigate LVF post-PPCI.
Background:
Primary percutaneous coronary intervention (PPCI) is pivotal in treating ST-elevation myocardial infarction (STEMI) patients, yet ischemia time significantly impacts outcomes, particularly left ventricular failure (LVF).
Objective:
This study aimed to investigate the impact of ischemia duration and other variables associated with severe left ventricular systolic dysfunction in STEMI patients receiving PPCI treatment.
Methodology:
This prospective cohort was carried out at Lady Reading Hospital in Peshawar, Pakistan, from January to June 2023. The study included 236 patients aged 18 to 70 with acute myocardial infarction who underwent PPCI within 12 hours of symptom onset. Patients with coronary dissection, late presenters (more than 12 hours after onset), those without stenting, and those with prior coronary artery intervention were excluded. Additionally, patients with systolic heart failure, a history of arrhythmias such as ventricular tachycardia or ventricular fibrillation, or a previous acute coronary syndrome event were excluded. Demographic information, clinical background, and ischemia duration were recorded and associated with left ventricular ejection fraction (LVEF) after PPCI. To identify predictors of severe left ventricular dysfunction, statistical analysis using SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.) included multivariate regression, Pearson's correlation, and descriptive statistics.
Results:
The patients' average age was 61.2 years (SD ± 12.3), with 35.59% of them being female (84 patients) and 64.41% of them being male (152 patients). Diabetes (33.05%, 78 patients) and hypertension (43.22%, 102 patients) were common comorbidities, and 14.41% (34 patients) had previously had a cardiac episode. Fifty-two patients (22.03%) of the total had ischemia within three hours, 94 patients (39.83%) had ischemia within six hours, 60 patients (25.42%) had ischemia within nine hours, and 30 patients (12.71%) had ischemia within 12 hours. Analysis of LVEF showed that 9.32% of patients (n=22) had LVEF <30% and 24.58% of patients (n=58) had LVEF 30-40%. Significant predictors of severe left ventricular systolic dysfunction were shown by multivariate regression to include ischemia duration (OR 1.45, p<0.001), age (OR 1.02, p=0.015), diabetes (OR 2.34, p=0.001), hypertension (OR 1.76, p=0.031), and previous cardiac events (OR 2.89, p=0.002); 20.33% of the patients (n=48) had LVF during the six-month follow-up, highlighting the therapeutic significance of prompt management in STEMI patients after PPCI.
Conclusion:
Prolonged ischemia, advanced age, diabetes, hypertension, and previous cardiac events that predict severe left ventricular dysfunction are associated with a greater risk of LVF following PPCI. Timely intervention and thorough therapy are essential for enhancing results for STEMI patients at high risk.
