Impact of Revascularization on Major Adverse Cardiovascular Events in Patients Without ST-Elevation Myocardial
Ibrahim Al-Zakwani1,2, Fahad AlKindi2,3, Wael Almahmeed4
1Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman.
Insights
Revascularization procedures like percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) significantly reduce major adverse cardiovascular events (MACE) in non-ST-elevation myocardial infarction (NSTEMI) patients. These treatments lowered stroke, mortality, and readmissions, improving patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Non-ST-elevation myocardial infarction (NSTEMI) is a critical cardiac condition.
- Revascularization strategies, including PCI and CABG, are key treatments.
- Understanding their impact in the Arabian Gulf region is important.
Purpose of the Study:
- To evaluate the effectiveness of PCI and CABG during index hospitalization for NSTEMI patients.
- To assess the impact on major adverse cardiovascular events (MACE).
- To analyze outcomes in the Arabian Gulf population.
Main Methods:
- Retrospective analysis of 1820 NSTEMI patients from 29 hospitals in four Arabian Gulf countries (Jan 2012-Jan 2013).
- Comparison of outcomes between patients who underwent PCI/CABG and those who did not, using propensity score matching.
- Inclusion criteria: discharged alive after index hospitalization.
Main Results:
- 29.1% of NSTEMI patients underwent revascularization (PCI or CABG).
- PCI/CABG patients showed significantly reduced MACE rates (25% vs. 43%, p < 0.001) compared to controls.
- Reductions were observed in stroke/TIA (2.4% vs. 7.0%, p = 0.005), all-cause mortality (4.5% vs. 7.0%, p < 0.001), and cardiac readmissions (20% vs. 31%, p = 0.001).
- No significant difference in reinfarction rates was noted.
Conclusions:
- Revascularization procedures (PCI/CABG) are associated with significant reductions in MACE for NSTEMI patients.
- These procedures notably decrease stroke/TIA, all-cause mortality, and cardiac-related readmissions.
- The findings support the use of revascularization in managing NSTEMI in the Arabian Gulf.
Abstract:
Objectives: The study evaluated the impact of revascularization procedures, including percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG), during the index hospitalization on major adverse cardiovascular events (MACE) in patients with non-ST-elevation myocardial infarction (NSTEMI) in the Arabian Gulf. Methods: Data were analyzed from 1820 consecutive patients diagnosed with NSTEMI, admitted to 29 hospitals in four Arabian Gulf countries from January 2012 to January 2013, and who were discharged alive. Results: Of the patients, 29.1% (n = 529) underwent either PCI (89.8%; n = 475) or CABG (10.2%; n = 54). The matching method (288 PCI/CABG patients were matched with 762 controls that did not undergo PCI/CABG) revealed significant reductions in MACE events among patients who had undergone PCI/CABG (25% vs. 43%; p < 0.001). This decrease was consistent across individual MACE components, including stroke/transient ischemic attack (TIA) (2.4% vs. 7.0%; p = 0.005), all-cause mortality (4.5% vs. 7.0%; p < 0.001) and cardiac-related readmissions (20% vs. 31%; p = 0.001) but not reinfarction (1.7% vs. 1.4%; p = 0.73). Conclusions: The revascularization procedures, PCI/CABG, were associated with significant reductions in annual MACE event rates, specifically lower stroke/TIA, all-cause mortality and cardiac-related readmissions.
