Key result
Primary percutaneous coronary intervention was associated with a significantly higher rate of complications compared to elective intervention (73.8% vs. 34.6%, p<0.001).
Why the study?
Complications and associated risk factors had not been directly compared between primary and elective PCI among patients presenting to an emergency department at a tertiary care center.
Does primary PCI have a higher rate of complications compared to elective PCI in adult patients?
Cross-Sectional (n=155)
No
Does primary PCI have a higher rate of complications compared to elective PCI in adult patients?
Absolute Event Rate: 73.8% vs 34.6%
p-value: p=<0.001
Primary PCI is associated with a significantly higher risk of complications, particularly no-reflow and hypotension, as well as higher mortality compared to elective PCI.
Higher complications with primary versus elective PCI warrant caution in acute settings; leaves open whether differences are causal without prospective data.
Objective: To compare the complications and associated risk factors between primary and elective percutaneous coronary intervention (PCI) among patients attending emergency department of a tertiary care hospital, Karachi, Pakistan.Methods: This retrospective cross-sectional study was conducted at Dr. Ziauddin University Hospital, Clifton campus, Karachi, from April 2019 to March 2021. All patients who underwent elective or primary PCI over the age of 18 years were included. The complications such as hypotension, coronary dissection, no-reflow, coronary perforation, arrhythmias, cardiac tamponade, stent thrombosis, and in-hospital death were observed. These complications were followed up till one month after the PCI. Results: Of total 155 patients, the mean age was 60.77 ± 11.15 years. There were 104 (67.1%) males and 51 (32.9%) females. Primary PCI was performed among 103 (66.5%) patients and elective PCI in 52 (33.5%) patients. Complications of PCI was observed in 94 (60.6%) patients. The most common complication presented was no-reflow 31 (32.9%). However, 14 (14.8%) patients presented with hypotension and 10 (10.5%) with hypotension along with no-reflow. Complications were found to be significantly higher in primary PCI 76 (73.8%) as compared to elective PCI 18 (34.6%) (p-value <0.001). Furthermore, mortality rate among primary PCI was found significantly higher as compared to elective PCI i.e., 13 (92.9%) vs. 1 (7.1%) (p-value 0.036).Conclusion: No-reflow, hypotension and hypotension along with no-reflow are a frequent complication of PCI especially when the patients undergo primary PCI as compared to elective intervention.
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Soomro et al. (2022) conducted a cross-sectional in Coronary artery disease requiring percutaneous coronary intervention (n=155). Primary percutaneous coronary intervention vs. Elective percutaneous coronary intervention was evaluated on Composite of complications (hypotension, coronary dissection, no-reflow, coronary perforation, arrhythmias, cardiac tamponade, stent thrombosis, and in-hospital death) (p=<0.001). Primary percutaneous coronary intervention was associated with a significantly higher rate of complications compared to elective intervention (73.8% vs. 34.6%, p<0.001).
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