Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2020; 12(4): 136-143
Published online Apr 26, 2020. doi: 10.4330/wjc.v12.i4.136
Comparative assessment of clinical profile and outcomes after primary percutaneous coronary intervention in young patients with single vs multivessel disease
Atif Sher Muhammad, Tariq Ashraf, Ayaz Mir, Syed Alishan, Faiza Farooq, Ali Ammar, Musa Karim, Syed Nadeem Hassan Rizvi, Tahir Saghir, Jawaid Akbar Sial, Naveed Ullah Khan
Atif Sher Muhammad, Tariq Ashraf, Ayaz Mir, Syed Alishan, Faiza Farooq, Ali Ammar, Syed Nadeem Hassan Rizvi, Tahir Saghir, Jawaid Akbar Sial, Naveed Ullah Khan, Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
Musa Karim, Department of Clinical Research, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
Author contributions: Muhammad AS, Ashraf T, Mir A, Alishan S, Farooq F, Ammar A, Karim M, Rizvi SNH, Saghir T, Sial JA, Khan NU contributed to the writing, revising of this manuscript.
Institutional review board statement: This study was conducted after the approval of the Ethical Review Committee of the National Institute of Cardiovascular Diseases (ERC-29/2019).
Informed consent statement: Informed consent was obtained from all the patients.
Conflict-of-interest statement: None to declare.
Data sharing statement: No additional data.
STROBE statement: The guidelines of the STROBE statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Atif Sher Muhammad, FCPS, MBBS, Doctor, Senior Registrar, Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Rafiqui (H.J.) Shaheed Road, Karachi 75510, Pakistan. dratifsher89@gmail.com
Received: October 29, 2019
Peer-review started: October 29, 2019
First decision: December 4, 2019
Revised: December 10, 2019
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 26, 2020
Abstract
BACKGROUND

Even though percutaneous coronary intervention (PCI) improved the survival of patients with acute myocardial infarction, still multivessel coronary artery disease remains an important factor burdening prognosis and it is being associated with a worse prognosis compared to single-vessel disease (SVD).

AIM

To compare the clinical profile and outcomes after the primary PCI in young patients with SVD vs multivessel disease (MVD).

METHODS

The retrospective cohort of patients were divided into two groups: SVD and MVD group. The study population consisted of both male and female young (≤ 45 years) patients presented with ST-elevation myocardial infarction (STEMI) at the National Institute of Cardiovascular Disease, Karachi, Pakistan and undergone primary PCI from 1st July 2017 to 31st March 2018. Pre and post-procedure management of the patients was as per the guidelines and institutional protocols.

RESULTS

A total of 571 patients with STEMI, ≤ 45 years were stratified into two groups by the number of vessels involved, 342 (59.9%) with SVD and 229 (40.1%) with MVD. The average age of these patients was 39.04 ± 4.86 years. A lower prevalence of hypertension and diabetes was observed in SVD as compare to MVD group (25.1% vs 38%, P < 0.01; 11.7% vs 27.5%, P < 0.001) respectively. While, smoking was more prevalent among the SVD group as compare to MVD group (36.3% vs 28.4%, P = 0.05). The high-C Lesion was observed in a significantly higher number of younger patients with MVD as compared to SVD group (48.8% vs 39.2%, P = 0.021). Post-procedure thrombolysis in myocardial infarction flow grade was found to be not associated with the number of diseased vessels with a P value of 0.426 and thrombolysis in myocardial infarction flow grade III was observed in 98% vs 96.5% of the patients is SVD vs MVD group.

CONCLUSION

The MVD comprised of around 40% of the young patients presented with STEMI. Also, this study shows that diabetes and hypertension have a certain role in the pathogenesis of multivessel diseases, therefore, preventive measures for diabetes and hypertension can be effective strategies in reducing the burden of premature STEMI.

Keywords: Young, Multivessel disease, Primary percutaneous coronary intervention, ST-elevation myocardial infarction, Premature coronary artery diseases, Single-vessel disease

Core tip: Premature coronary artery diseases are at rise. Multivessel disease (MVD) is associated with poor prognosis. MVD comprised of around 40.1% of the young patients with ST-elevation myocardial infarction. Prevalence of hypertension and diabetes was high in ST-elevation myocardial infarction patients with MVD. In-hospital outcomes of primary percutaneous coronary intervention were not different for patient with MVD.