COMPARISON OF THE OUTCOMES BETWEEN PERCUTANEOUS CORONARY INTERVENTION ALONE AND PHARMACOINVASIVE CORONARY INTERVENTION AMONG ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) PATIENTS
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Date
2025-02-03
Authors
Ma’ali, Basel Khairy Ali
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Publisher
An-Najah National University
Abstract
Background: Myocardial infarction is among the most diagnosed cardiological diseases in the whole world and in Palestine, and is managed mainly by invasive interventions to control or treat coronary artery occlusion, while some centers add tissue plasminogen activator to the plan in what so called pharmacoinvasive approach. The incidence of postoperative complications is inevitable, and therefore, the aim of the current study is to identify the most common complications compared between two myocardial infarction management approaches (percutaneous and pharmacoinvasive coronary interventions) in two tertiary centers in Ramallah and Nablus, and determine the most common risk factors associated with the differences between them.
Methodology: The study utilized retrospective cohort design on a randomized sample of 160 adult (30 – 75 years old) patients who were admitted to intensive care cardiology departments of Palestine Medical complex (for pharmacoinvasive approach) and An-Najah National University Hospital (for percutaneous coronary intervention approach). The researcher used a data sheet that was developed based on previous literature, and data were analyzed using software.
Results: Patients who underwent percutaneous coronary intervention (n = 82, 51.2%) were significantly older (mean = 59.8 ± 9.7 vs 56.2 ± 12.7) than pharmacoinvasive (n = 78, 48.8%). Catheter insertion site was mostly radial in percutaneous coronary intervention patients (95.1%) compared to pharmacoinvasive (15.4%), with no significant difference in MI location. Patients with percutaneous coronary intervention patients showed more significant decrease in white blood cells, low-density lipoprotein, high-density lipoprotein, triglyceride and heart rate, with more significant increase in troponin-I, and less increase in sodium, compared to pharmacoinvasive patients (p-value < 0.05) between pre- and post-operative phases. All postoperative complications, except for upper gastrointestinal bleeding, and mortality rate were significantly higher among pharmacoinvasive patients (p-value < 0.05). Lastly, significantly more postoperative complications were found among patients with dyslipidemia, valve regurgitation and cardiac hypokinesia.
Conclusion: Patients who were treated with pharmacoinvasive approach showed higher postoperative complications and 30-day mortality rate. More research is needed in this area of cardiology management in Palestine. A prospective design is also recommended to be conducted for this topic in the future research.