Clinical Outcomes and Associated Factors in Patients Who Successfully Underwent Percutaneous Coronary Intervention: A 5-Year Multicenter Retrospective Crossectional Study
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Date
2023-10
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Addis Ababa University
Abstract
Background: Myocardial infarction (MI) is the leading cause of death globally, with the majority
of death occurring in low-and middle-income countries (LMICs). Percutaneous coronary
intervention (PCI) became a standard management modality to improve patients’ quality of life and
reduce mortality when combined with pharmacologic therapy. However, the PCI service was not
well-practiced in Ethiopian health facilities and also poor outcomes had previously been reported.
Objective: To assess the clinical outcomes and associated factors among myocardial infarction
patients who underwent successful PCI in Addis Ababa, Ethiopia.
Methods: A retrospective crossectional study was conducted at three healthcare facilities from
March 01 to May 31, 2022. A total of 241 MI patients who underwent successful PCI between
January 1, 2017, and December 31, 2021, were included. The outcome measures were in-hospital
mortality, non-fatal major adverse cardiac and cerebrovascular events (MACCEs) and complication
rates. Data were analyzed using SPSS version 21.0. Multivariable Cox-regression was carried out to
identify predictors of in-hospital mortality. Variable with p -a value < 0.05 was considered
statistically significant. Kaplan Meier analyses were also used to determine overall survival rates
and median survival time.
Results: Out of 241 participants, 194 (80.5%) were males and the mean age was57.2 ± 10.6 years.
One hundred eight-three (75.9%) patients had ST-elevated myocardial infarction (STEMI).
Dyslipidemia 198 (82.2%) was the leading risk factor for MI. One twenty three (51%) patients
received pharmaco-invasive PCI and drug-eluting stent (DES) implantation (181, 75.1%) was the
most commonly used reperfusion method in the study settings. The most commonly used
medications in these patients were statins (100%) and aspirin (92.6%), followed by clopidogrel
(88.4%). In-hospital mortality and non-fatal MACCEs rates were 3.7% and 24.1%, respectively.
The predictors for in-hospital mortality were being female (AHR=8.39, 95% CI: 1.20-58.68, P=
0.03), pre-procedural obesity (AHR=6.54, 95% CI: 1.10-40.60, P=0.04), previous MI (AHR=9.68,
95% CI: 1.66-56.31, P=0.01), chronic heart failure (AHR=9.21, 95% CI: 1.38-61.78, P=0.02) and
having previous history of stroke (AHR=18.99, 95% CI: 1.59-227.58, P=0.02). The overall
estimated 1-year survival rate of MI patients who underwent successful PCI was 96.3%.
Conclusion and recommendation: Pharmaco-invasive PCI was the most commonly deployed
intervention in patients with myocardial infraction. The overall in-hospital mortality rate was low
and about a quarter of study patients developed non-fatal MACCEs. The estimated one-year
survival rate was higher. Although the current study's findings appear to be better, there is still
improvement to be made in terms of providing essential medications, proper documentation of
patient data, and expanding access of reperfusion therapy in the country
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Keywords
Percutaneous coronary intervention, successful PCI, clinical outcomes, myocardial infarction, major adverse cardiac and cerebrovascular events