Evaluation of factors associated with preprocedural myocardial injury following elective PCI in Shahid Madani Hospital

Abstract

Percutaneous coronary intervention (PCI) has become the predominant procedure for coronary revascularization in patients with both stable and unstable coronary artery disease (CAD). Over the past two decades, technical advances in PCI have resulted in a better and safer therapeutic procedure with minimal procedural complications. However, about 30% of patients undergoing elective PCI sustain myocardial injury arising from the procedure itself, the extent of which is significant enough to carry prognostic importance. The peri-procedural injury which accompanies PCI might therefore reduce some of the beneficial effects of coronary revascularization. The availability of more sensitive serum biomarkers of myocardial injury such as creatine phosphokinase MB isoenzyme (CK-MB), Troponin T, and Troponin I has enabled the quantification of previously undetectable myocardial injury.Aim: 1- Evaluation of the relationship between underlying diseasesand the incidence of myocardial injury in patients undergoing angioplasty 2- Evaluation of the relationship between drugs used and myocardial damage in patients undergoing angioplasty 3- Evaluation of the relationship between factors involved in angioplasty with the incidence of myocardial damage in patients undergoing angioplasty.Methods: In this study, the records of 210 patients who underwent elective angioplasty in a civic center are reviewed retrospectively. The cardiovascular risk factors of patients including age, sex, type of disease, drugs used, factors involved in angioplasty including the number of stents and the location of blood vessels were investigated. Logistic regression analysis and correlation tests such as Kendal Rank Correlation and Spearman were used to analyze the data in SPSS version 23 system. Results:Many factors may influence myocardial injury following PCI such as: -Patient-related factors: Patient factors implicated for higher incidence of PMI include older age, multi-vessel CAD, diffuse CAD, systemic atherosclerosis, pre-existing renal impairment, presence of anemia, preprocedural C-reactive protein elevation and etc.-Factors related to the vessel involved: Such as the anatomy of the vessel, the size of the affected area, the branching of the vessel, calcification, the accumulation and movement of plaque and the formation of unstable plaque.- Factors related to the process: The longer stent and the thicker vessel, the more likely it is to damage the vessel. Conclusion: The incidence of PMI was associated with old age. Among diabetic patients who used statin and nitrate the incidence significantly was lowered.