Periprocedural myocardial infarction during percutaneous coronary intervention in an academic tertiary centre in Johannesburg☆,☆☆

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Abstract

Background

Percutaneous coronary intervention (PCI) is effective therapy for significant atherosclerotic coronary artery disease. Despite medical and technological advances in PCI, periprocedural myocardial infarction (PMI) remains a common complication. The frequency and factors associated with PMI have been well investigated in the developed world, yet there is a paucity of data from the developing world, especially Sub-Saharan Africa.

Methods

We prospectively enrolled 153 adult patients undergoing PCI at the Charlotte Maxeke Johannesburg Academic Hospital from the 1st of February 2014 to 31st October 2014. Periprocedural Creatinine Kinase-MB and hs-Troponin I were routinely measured before PCI and at 16–24 h post-procedure. The third universal definition of myocardial infarction was used to define a PMI event.

Results

152 participants met the inclusion criteria and were analysed for PMI. 70.4% participants were male. The mean age was 58.8 (SD 10.9) years old. Sixteen (10.5%) participants fulfilled the criteria for PMI. Side branch pinching with preserved TIMI III flow was noted in 62.5% of PMI cases. Duration of procedure (P = 0.007), right coronary artery intervention (p = 0.042) and total stent length (p = 0.045) were independently associated with PMI.

Conclusion

PMI occurred in 10.5% of cases undergoing PCI. This is consistent with the prevalence of PMI internationally. Larger multicentre studies are required in our demographic region to further define relevant predictors and outcomes associated with PMI.

Introduction

Coronary artery disease (CAD) has the highest global burden of morbidity and mortality [1], [2]. This is also true for the developing world where there has been significant urbanisation [3], [4]. Percutaneous coronary intervention (PCI) is a widely accepted therapeutic modality for physiologically significant CAD [5]. Periprocedural myocardial infarction (PMI) is a common complication of PCI and well documented in developed countries [6]. However, there is a paucity of data from developing regions, especially in sub-Saharan Africa on the prevalence of PMI despite an increasing incidence of CAD and concomitant increase in PCI.

The aim of the current study was to define the local incidence of PMI, to identify relevant risk factors in our study population associated with PMI, and to compare findings to those reported in developed regions.

Section snippets

Study design and population

This observational study was conducted from the 1st of February 2014 to 31st October 2014. One hundred and fifty-three consecutive and eligible patients undergoing PCI at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa were prospectively recruited. This hospital is situated in the heart of Johannesburg with a cardiology unit that functions as a referral point for primary and secondary hospitals without cardiac catheterisation capabilities. These referring

Results

During the 10-month study period 153 participants were recruited. One patient was excluded from the analysis due to a laboratory technical error. (Fig. 1).

Using the third universal definition of myocardial infarction related to PCI (Type 4a), the incidence of PMI in this study was found to be 10.5% (n = 16). There were no significant demographic or anthropometric differences between those who developed PMI and those who did not (Table 1).

The mean age of the study population was 58.8 (SD 10.9)

Discussion

The present study is the first systematic study in Sub-Saharan Africa investigating the incidence of PMI according to the third universal definition of myocardial infarction [7]. Despite operating in a resource limited centre with restricted access to newer antiplatelet agents and novel coronary imaging modalities which have been shown to prevent and better predict PMI [11], [12], [13], [14], the incidence of PMI in our cohort was 10.5%. This is consistent with the prevalence of PMI

Conclusion

The results of this single centre, prospective observational study has found an incidence of PMI to be 10.5%. Despite being in a resource limited environment this is consistent with the prevalence of PMI internationally. Larger multicentre studies are required in our demographic region to further define relevant predictors and outcomes of PMI.

Disclosures

The authors report no relationships that could be construed as a conflict of interest.

Acknowledgements

The authors would like to thank Sr. R Zwapano, Sr. M Modiga, Mrs. R Kgomommu, Sr. P Ewing, Sr. V Paton, the catheterisation laboratory staff and the coronary care unit staff for their administrative and logistical support.

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    These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their interpretation.

    ☆☆

    Acknowledgement of Grant Support: none.

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