Major adverse cardiovascular event (MACE) after percutaneous coronary intervention in one-year follow-up study

Authors

  • Ahmadnoor Abdi M.D. Interventional Cardiologist, Assistant Professor of Cardiology, Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

Keywords:

Percutaneous coronary interventions, Myocardial Infarction, Stroke

Abstract

Background: Percutaneous coronary intervention (PCI) is the most common revascularization procedure, with over 1 million performed each year, worldwide. Over the past 20 years, the increasing experience of operators coupled with the advent of newer technologies, including coronary stents and a variety of adjuvant drug therapies, have permitted more successful procedures and decreased the morbidity associated with PCIs. Objective: To identify the incidence, predictors, and clinical implications of Major Adverse Cardiovascular Events (MACE) after PCIs. Methods: This descriptive cross-sectional study was done in Bandar Abbas in Iran in 2015. All patients which treated with PCI in Shahid Mohammadi Hospital during a one-year period were employed. A total of 192 patients were included. At one-year follow-up in this study, incidence and predictors of MACE were evaluated in a prospective study. The data were analyzed by SPSS 19.0 and descriptive tests included frequency and percentage and mean and standard deviation. Also, Chi-square test was used for data analysis. A p value <0.05 was determined as significant. Result: Of the 192 patients, 126 (65.6%) were men and 66 patients were female. Stent had been implemented in 93.8% of patients. Sixty two percent of patients were treated with only one stent, two stents were deployed in 29.7% of patients and 3.6% of patients were treated with three or more stents. Of these patients, 46.9% were treated with Drug Eluted Stent (DES) and 40.1% were treated with Bare Metal Stent (BMS). Both types of stents were used in 8.3% of patients. Also, 4.7% of the patients were treated with balloon angioplasty (POBA). Angioplasty success rate was 95.3% and procedural success rate defined as achieving TIMI III flow with residual coronary stenosis under 30%. No in-hospital mortality or emergency CABG was reported. Re-admission in first year after PCI was required in 34 (17.7%) patients of which, 20 of them (10.4%) needed target vessel revascularization (TVR). Readmission was significantly higher (p=0.034) in the group with BMS compared to those who had DES. MI occurred in 8 patients.  Conclusion: Our study showed the superiority of DES in comparison with BMS in decreasing readmission and less TVR, but no effect on long term mortality. We recommend more studies in this setting because patients in special groups may benefit more from DES or BMS.

 

References

Montalescot G, Ongen Z, Guindy R, Sousa A, Lu SZ, Pahlajani D, et al. Predictors of outcome in patients

undergoing PCI. Results of the RIVIERA study. Int J Cardiol. 2008; 129(3): 379-87. doi:

1016/j.ijcard.2007.07.127. PMID: 18055032.

Gruntzig AR, Senning A, Siegenthaler WE. Nonoperative dilatation of coronary-artery stenosis:

percutaneous transluminal coronary angioplasty. N Engl J Med. 1979; 301(2): 61-8.

1056/NEJM197907123010201. PMID: 449946.

Fischman DL, Leon MB, Baim DS, Schatz RA, Savage MP, Penn I, et al. A randomized comparison of

coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med. 1994; 331(8): 496-501. doi:

1056/NEJM199408253310802. PMID: 8041414.

Caixeta A, Leon MB, Lansky AJ, Nikolsky E, Aoki J, Moses JW, et al. 5-year clinical outcomes after

sirolimus-eluting stent implantation insights from a patient-level pooled analysis of 4 randomized trials

comparing sirolimus-eluting stents with bare-metal stents. J Am Coll Cardiol. 2009; 54(10): 894-902. doi:

1016/j.jacc.2009.04.077. PMID: 19712798.

Yeh RW, Normand SL, Wolf RE, Jones PG, Ho KK, Cohen DJ, et al. Predicting the restenosis benefit of

drug-eluting versus bare metal stents in percutaneous coronary intervention. Circulation. 2011; 124(14):

-64. doi: 10.1161/CIRCULATIONAHA.111.045229. PMID: 21900079.

Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C, et al. Early and late coronary stent

thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large

two-institutional cohort study. Lancet. 2007; 369(9562): 667-78. doi: 10.1016/S0140-6736(07)60314-6.

PMID: 17321312.

Lagerqvist B, James SK, Stenestrand U, Lindback J, Nilsson T, Wallentin L, et al. Long-term outcomes

with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med. 2007; 356(10): 1009-19. doi:

1056/NEJMoa067722. PMID: 17296822.

Farshidi H, Zarenezhad M, Zare Sh, Mousavi SA, Mozafari SA. Coronary Artery Disease Risk Factors in

Truck Drivers, Bandar Abbas, Iran (2009-2010). Journal of Rafsanjan University of Medical Sciences.

; 12(3): 195-204.

Kirtane AJ, Gupta A, Iyengar S, Moses JW, Leon MB, Applegate R, et al. Safety and efficacy of drug- eluting and bare metal stents: comprehensive meta-analysis of randomized trials and observational studies.

Circulation. 2009; 119(25): 3198-206. doi: 10.1161/CIRCULATIONAHA.108.826479. PMID: 19528338.

MacKenzie TA, Malenka DJ, Olmstead EM, Piper WD, Langner C, Ross CS, et al. Prediction of survival

after coronary revascularization: modeling short-term, mid-term, and long-term survival. Ann Thorac Surg.

; 87(2): 463-72. doi: 10.1016/j.athoracsur.2008.09.042. PMID: 19161761.

Qureshi MA, Safian RD, Grines CL, Goldstein JA, Westveer DC, Glazier S, et al. Simplified scoring

system for predicting mortality after percutaneous coronary intervention. J Am Coll Cardiol. 2003; 42(11):

-5. doi: 10.1067/mhj.2002.125505. PMID: 14662247.

Holubkov R, Laskey WK, Haviland A, Slater JC, Bourassa MG, Vlachos HA, et al. Angina 1 year after

percutaneous coronary intervention: a report from the NHLBI Dynamic Registry. Am Heart J. 2002;

(5): 826-33. PMID: 12422151.

Stone GW, Lansky AJ, Pocock SJ, Gersh BJ, Dangas G, Wong SC, et al. Paclitaxel-eluting stents versus

bare-metal stents in acute myocardial infarction. N Engl J Med. 2009; 360(19): 1946-59. doi:

1056/NEJMoa0810116. PMID: 19420364.

Kastrati A, Mehilli J, Dirschinger J, Dotzer F, Schuhlen H, Neumann FJ, et al. Intracoronary stenting and

angiographic results: strut thickness effect on restenosis outcome (ISAR-STEREO) trial. Circulation. 2001;

(23): 2816-21. PMID: 11401938.

Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy

with or without PCI for stable coronary disease. N Engl J Med. 2007; 356(15): 1503-16.

1056/NEJMoa070829. PMID: 17387127.

Mehta SR, Cannon CP, Fox KA, Wallentin L, Boden WE, Spacek R, et al. Routine vs selective invasive

strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials.

JAMA. 2005; 293(23): 2908-17. doi: 10.1001/jama.293.23.2908. PMID: 15956636.

Kassaian SE, Saroukhani S, Alaeddini F, Salarifar M, Capodanno D, Poorhoseini H, et al. A Risk-Scoring

Model to Predict One-year Major Adverse Cardiac Events after Percutaneous Coronary Intervention. J

Tehran Heart Cent. 2015; 10(4): 167-75. PMID: 26985204, PMCID: PMC4791644.

Khosravi A, Pourmoghaddas M, Asadi K, Abdi A, Gholamrezaei A. Immediate results and six-month

outcomes after percutaneous coronary intervention in a referral heart center in Isfahan, Iran. ARYA

Atheroscler. 2011; 7(1): 24-30. PMID: 22577441, PMCID: PMC3347842.

Farshidi H, Rahimi S, Abdi A, Salehi S, Madani A. Factors Associated With Pre-hospital Delay in Patients

With Acute Myocardial Infarction. Iran Red Crescent Med J. 2013; 15(4): 312-6. doi: 10.5812/ircmj.2367.

PMID: 24083004, PMCID: PMC3785905.

Shishehbor MH, Amini R, Oliveria LP, Singh IM, Kelly P, Bhatt DL, et al. Comparison of drug-eluting

stents versus bare-metal stents for treating ST-segment elevation myocardial infarction. JACC Cardiovasc

Interv. 2008; 1(3): 227-32. doi: 10.1016/j.jcin.2008.03.011. PMID: 19463304.

Slottow TL, Steinberg DH, Roy P, Javaid A, Buch AN, Okabe T, et al. Drug-eluting stents are associated

with similar cardiovascular outcomes when compared to bare metal stents in the setting of acute myocardial

infarction. Cardiovasc Revasc Med. 2008; 9(1): 24-8. doi: 10.1016/j.carrev.2007.06.002. PMID: 18206634.

Stettler C, Wandel S, Allemann S, Kastrati A, Morice MC, Schomig A, et al. Outcomes associated with

drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet. 2007; 370(9591): 937- 48. doi: 10.1016/S0140-6736(07)61444-5. PMID: 17869634.

Published

2021-12-24