In-hospital Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Peri-urban Area Hospital Without Cardiac Surgery Backup

Authors

DOI:

https://doi.org/10.22502/jlmc.v9i2.451

Keywords:

Cardiac surgery, Percutaneous coronary intervention, Post percutaneous coronary intervention complications

Abstract

Introduction: In centers without cardiac surgery backup, current guidelines recommend to conduct emergency percutaneous coronary intervention and discourage elective percutaneous coronary intervention. The objective of the study was to evaluate the feasibility and safety of percutaneous coronary intervention in patients with stable coronary artery disease, acute coronary syndrome, and ST segment elevation myocardial infarction in periurban area of Nepal without on-site cardiac surgical facilities. Methods: This retrospective single-centered study was done at College of Medical Sciences, Bharatpur, Nepal. The study included 600 patients who underwent percutaneous coronary intervention in the cardiology department cath lab from January 2014 to March 2020. Patients were evaluated for in-hospital outcomes, procedural success and post percutaneous coronary intervention complications within seven days of hospital stay. Results: Seventy percent (n=420) of percutaneous coronary intervention was emergency percutaneous coronary intervention for acute coronary syndrome and 30% (n=180) of percutaneous coronary intervention was done as an elective percutaneous coronary intervention for stable angina. Procedural success was 98% (n=176) for elective percutaneous coronary intervention and 93% (n=390) for emergency percutaneous coronary intervention. Sixteen percent (n=96) patients developed acute kidney injury, six percent (n=36) of patients developed pulmonary edema and cardiogenic shock respectively, 2% (n=12) patients developed post percutaneous coronary intervention myocardial infarction, 3% (n=18) patients developed bleeding complications, 0.5% (n=3) patients developed stroke and death rate was 3% (n=18). Conclusion: Percutaneous coronary intervention can be done with comparable and acceptable safety in peri-urban area hospital of Nepal without cardiac surgery backup with dedicated and experienced team.

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Author Biographies

  • Manoj Shrestha, College of Medical Sciences, Bharatpur, Chitwan, Nepal.

    Lecturer,

    Department of Cardiology.

  • Prakash Aryal, College of Medical Sciences, Bharatpur, Chitwan, Nepal.

    Lecturer,

    Department of Internal Medicine.

References

Carlsson J, James SN, Ståhle E, Höfer S, Lagerqvist B. Outcome of percutaneous coronary intervention in hospitals with and without on-site cardiac surgery standby. Heart. 2007;93(3):335-8. PMID: 16980517 DOI: https://doi.org/10.1136/hrt.2006.098061

Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017;135(10):e146-e603. PMID: 28122885 DOI: https://doi.org/10.1161/cir.0000000000000485

Bhattarai S, Aryal A, Pyakurel M, Bajracharya S, Baral P, Citrin D, et al. Cardiovascular disease trends in Nepal – An analysis of global burden of disease data 2017. Int J Cardiol Heart Vas. 2020;30:100602. PMID: 32775605 DOI: https://doi.org/10.1016/j.ijcha.2020.100602

Singh M, Gersh BJ, Lennon RJ, Ting HH, Holmes DR Jr, Doyle BJ, et al. Outcomes of a system-wide protocol for elective and nonelective coronary angioplasty at sites without on-site surgery: the Mayo Clinic experience. Mayo Clin Proc. 2009;84(6):501-8. PMID: 19483166 DOI: https://doi.org/10.1016/s0025-6196(11)60581-8

Lee JM, Hwang D, Park J, Kim K-J, Ahn C, Koo B-K. Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup. Circulation. 2015;132(5):388-401. DOI: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.115.016137

Akasaka T, Hokimoto S, Sueta D, Tabata N, Oshima S, Nakao K, et al. Clinical outcomes of percutaneous coronary intervention for acute coronary syndrome between hospitals with and without onsite cardiac surgery backup. J Cardiol. 2017;69(1):103-9. PMID: 26928574 DOI: https://doi.org/10.1016/j.jjcc.2016.01.012

Singh M, Holmes DR Jr, Dehmer GJ, Lennon RJ, Wharton TP, Kutcher MA, et al. Percutaneous Coronary Intervention at Centers With and Without On-site Surgery: A Meta-analysis. JAMA. 2011;306(22):2487-94. PMID: 22166608 DOI: https://doi.org/10.1001/jama.2011.1790

Chui PW, Parzynski CS, Nallamothu BK, Masoudi FA, Krumholz HM, Curtis JP. Hospital Performance on Percutaneous Coronary Intervention Process and Outcomes Measures. J Am Heart Assoc. 2017;6(5):e004276. PMID: 28446493 DOI: https://doi.org/10.1161/jaha.116.004276

Koolen KH, Mol KA, Rahel BM, Eerens F, Aydin S, Troquay RP, et al. Off-site primary percutaneous coronary intervention in a new centre is safe: comparing clinical outcomes with a hospital with surgical backup. Neth Heart J. 2016;24(10):581-8. PMID: 27595816 DOI: https://doi.org/10.1007/s12471-016-0872-0

Angelini P. Guidelines for surgical standby for coronary angioplasty: should they be changed? J Am Coll Cardiol. 1999;33(5):1266-8. PMID: 10193726 DOI: https://doi.org/10.1016/s0735-1097(99)00002-9

Numasawa Y, Kohsaka S, Ueda I, Miyata H, Sawano M, Kawamura A, et al. Incidence and predictors of bleeding complications after percutaneous coronary intervention. J Cardiol. 2017;69(1):272-9. PMID: 27269413 DOI: https://doi.org/10.1016/j.jjcc.2016.05.003

Fuchs S, Stabile E, Kinnaird TD, Mintz GS, Gruberg L, Canos DA, et al. Stroke Complicating Percutaneous Coronary Interventions: Incidenc, predictors, and prognostic implicattions. Circulation. 2002;106(1):86-91. PMID: 12093775 DOI: https://doi.org/10.1161/01.cir.0000020678.16325.e0

Alkhouli M, Alqahtani F, Tarabishy A, Sandhu G, Rihal CS. Incidence, Predictors, and Outcomes of Acute Ischemic Stroke Following Percutaneous Coronary Intervention. JACC Cardiovasc Interv. 2019;12(15):1497-1506. PMID: 31395220 DOI: https://doi.org/10.1016/j.jcin.2019.04.015

Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv. 2014;7(1):1-9. PMID: 24456715 DOI: https://doi.org/10.1016/j.jcin.2013.06.016

Kanic V, Kompara G, Å uran D, Tapajner A, Naji FH, Sinkovic A. Acute kidney injury in patients with myocardial infarction undergoing percutaneous coronary intervention using radial versus femoral access. BMC Nephrol. 2019;20(1):28. PMID: 30700270 DOI: https://doi.org/10.1186/s12882-019-1210-8

French JK, Armstrong PW, Cohen E, Kleiman NS, O'Connor CM, Hellkamp AS, et al. Cardiogenic shock and heart failure post–percutaneous coronary intervention in ST-elevation myocardial infarction: Observations from “Assessment of Pexelizumab in Acute Myocardial Infarctionâ€. Am Heart J. 2011;162(1):89-97. PMID: 21742094 DOI: https://doi.org/10.1016/j.ahj.2011.04.009

König S, Boudriot E, Arya A, Lurz J-A, Sandri M, Erbs S, et al. Incidence and characteristics of ventricular tachycardia in patients after percutaneous coronary revascularization of chronic total occlusions. PLoS One. 2019;14(11):e0225580. PMID: 31756220 DOI: https://doi.org/10.1371/journal.pone.0225580

Mehta RH, Harjai KJ, Grines L, Stone GW, Boura J, Cox D, et al. Sustained ventricular tachycardia or fibrillation in the cardiac catheterization laboratory among patients receiving primary percutaneous coronary intervention: Incidence, predictors, and outcomes. J Am Coll Cardiol. 2004;43(10):1765-72. PMID: 15145097 DOI: https://doi.org/10.1016/j.jacc.2003.09.072

Kutcher MA, Klein LW, Ou FS, Wharton TP Jr, Dehmer GJ, Singh M, et al. Percutaneous coronary interventions in facilities without cardiac surgery on site: a report from the National Cardiovascular Data Registry (NCDR). J Am Coll Cardiol. 2009;54(1):16-24. PMID: 19555835 DOI: https://doi.org/10.1016/j.jacc.2009.03.038

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Published

2021-12-30

Issue

Vol. 9 No. 2 (2021): vol:9, issue:2

Section

Original Research Article

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How to Cite

1.
In-hospital Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Peri-urban Area Hospital Without Cardiac Surgery Backup. J Lumbini Med Coll [Internet]. 2021 Dec. 30 [cited 2026 Apr. 30];9(2):5 pages. Available from: https://jlmc.edu.np/index.php/JLMC/article/view/451