الفهرس 
Percutaneous coronary interventionOnly 14 pages are availabe for public view
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Abstract
The universal definition of MI adopted by the American College of Cardiology (ACC) defined PCI-related myocardial infarction as an increase of biomarkers (CK-MB or troponin) greater than 3 times ULN, and considered elevations of cardiac biomarkers between 1 and 3 times ULN as indicative of periprocedural myocardial necrosis but not infarction. An isolated rise in troponin above 3 times ULN was considered enough to define PMI ( Alpert JS et al., 2000 , Thygesen K et al., 2007) . Periprocedural MI and spontaneous MI unrelated to PCI (typically due to atherosclerotic plaque rupture) are often equated as outcome measures in clinical trials, including the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial. The validity of this practice is questionable as the mechanisms of PMI and spontaneous MI are different, the long-term prognosis is potentially different, and the definition of PMI is inconsistent across trials. (Thygesen K et al., 2007). This study was conducted on one hundred and fifty (150 ) patients with elective percutaneous coronary intervention who were admitted to the new kasr al - aini teatching hospital, during the period from 7/2012 till 7/2013. All the patients were subjected to:- 1. Full history taken ,including history of drugs taken before PCI which influence the incidence of PMI . 2. Full clinical examination . 3.Baseline E.C.G. 4.Echocardiography. 5.Laboratory investigations (CBC, liver functions, kidney functions, coagulation profile). 6. Serum Troponin-I was done before procedure to evaluate the baseline level before PCI. 7. Elective percutaneous coronary intervention (PCI) was done to all patients. 8. We determined the number of lesions, percent of stenosis, the selected vessels for PCI, number of vessels in which PCI done , number of balloon used , number and types of stents , type and amount dye used. 9. We recorded if there is procedural complications as dissection, no reflow , pacemaker application , cardiac arrest . 10. After PCI all patients screened for periprocedural MI by estimate the range of S.Troponin level 6-8h post PCI . 11. The patients with elevated Troponin 3-5 folds above the base line cardiac enzymes were considered to have periprocedural MI . (Thygesen K et al., 2007) . 12. We divided the study population into 2 groups :- I-First group (PMI cases) patients with elevated Troponin –I post procedure. II-Second group (Non PMI cases) patients with no elevation of Troponin-I post procedure. 13. All the results were tabulated and statistically analysed. In summary,The present study showed the following results:- 1. Out of 150 studied patients, 119 patients (79.3 %) were males and 31 patients (20.7%) were females. The mean and standard deviation of the age of studied cases was 55 ± 5.52. 2. 127 patients (84.7 %) were hypertensive , 113 patients (78.3%) were diabetics , 104 patients (69.3%) were smokers , 70 patients (46.7%) were obese , Mean LDL level ( 182 +/- 33.2) , 12 patients ( 8%) had renal impairment,NYHA class I,II in 150 patients(100%) , Non of our patients had NYHA class III, IV, 30 patients (20%) had history of prior MI, 33 (22%) had impaired E.F , 146 patients (97.3%) hadprior history of unstable angina before PCI, 32 patients (21.3%) had prior PCI , and 5 patients (3.3%) had prior CABG. 3. The target vessel for PCI was proximal LAD in 50 patients (33.3%) , Diagonals only in 3 patients (2%), LCX(without affection of O.M) in11 patients ( 7.3% ) ,Obtuse marginal in 4 patients (2.7%) , RCA in 22 patients ( 14.7%) , ramus intermedius in one patient ( 0.67%) , grafts for CABG in one patient which present (7% ). 4. DES only were used in 60 patients (40%), BMS only were used in 85 patients (56.7%), and a combined stents were used in 5 patients (3.4%). 5. 18 patients (12%) of multiple stenting, 44 patients (29.3%) had proximal LAD stenting,16 patients (10.7%) had LAD multiple stenting. 7. 74 patients (49.3%) had direct stenting , 76 patients (50.6%) PTCA and stenting were done. 8. Out of 150 studied patients, 7 patients (4.7%) had dissection,2 patients ( 1.3%) had no reflow, no cases had plaque shift, thrombus formation, side branch occlusion and bleeding. 9.Out of 150 patients of study population ,15 patients (10%) developed PMI . 10. There is a higher incidence of diabetes among PMI patients comparing PMI vs Non PMI respectively , (98.7% vs 74.1% ,P value 0.022) , a higher mean LDL level (190 vs 170,p value 0.021) , a higher mean T.cholesterol (290 vs 182 ,p value 0.001), renal impairment(20% vs 6.7% , pvalue 0.042)and impaired E.F <40% ( 33.3% vs 20.7%, p value 0.022)among patients with PMI. 11.There was Statistically significant lower incidence of hypertension (66.7% vs 86.7%, p 0.039) among patients with PMI. 12. No statistically significant difference between both groups as regard smoking (73.3% vs 68.9%, P value 0.362) , prior PCI(26.7% vs 20.7%, p value 0.362) , history of prior MI(13.3% vs 20.7%, p value 0.231) , prior history of unstable angina( 100% vs 97%,p value 0.852). 13. No statistically significant difference between both groups as regard use of statin(47.3% vs 93.4%, p value 0.357). 14. The selection of RCA for PCI (20% vs 14.1%, p value 0.011) , proximal LAD as selected vessel (40 % vs 32.6 %,p value 0.020) were statistically significant higher in PMI patients . 15. There is statistically significant higher incidence of PMI among cases with DES usage. 16. There was statistically significant higher incidence of proximal LAD stenting (46.7% vs 31.8% ,p value 0.020)and multiple LAD stenting (20% vs 9.6% ,p value 0.005)among patients with PMI. 17. There is Statistically significant higher incidence of multiple stenting(20% vs 11.1%, p value 0.028) ,While there was Statistically significant lower incidence of direct stenting(26.7% vs 51.9% ,p value 0.005) in PMI patients in relation to combined PTCA and stenting(66.6% vs 46.6% ). 18. The identified mechanisms of PMI were dissection (4patients , 26.7%), no reflow(2 patients , 13.3%) among patients with PMI and in (60%) of PMI patients , the mechanisms was unidentified. 19. the univariate predictors of periprocedural myocardial infarction included high LDL(odds ratio 3.66, p value 0.021) , high T.cholesterol(odds ratio 1.33, p value 0.001) , Prior CABG (odds ratio 2.15, p value 0.013) , impaired E.F(odds ratio 1.10, p value 0.022), RCA as selected Vessel(odds ratio 1.24, p value 0.011) , usage of DES(odds ratio 1.99, p value 0.006) and direct stentin (odds ratio 1.99, p value 0.003) . 20. the independent predictors of periprocedural myocardial infarction among the study population include high T.cholesterol (odds ratio 1.20, p value 0.001) , RCA as selected vessel(odds ratio 1.29, p value 0.011) and usage of DES (odds ratio 1.97, p value 0.006) .