Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT: BACKGROUND: Percutaneous Coronary Intervention ; PCI has become important tool of treating patients with Ischaemic Heart Disease however it is associated with serious complications. OBJECTIVE: This paper is a survey of the complications that occur during hospitalization for such treatment of patients with Non-ST-Elevation Acute Coronary syndrome, assess relation of those complications with the clinical severity, and with number of five classical predisposing Risk Factors for atherosclerosis METHODS: Data of 142 consecutive hospital pts with Non-ST-Elevation Acute Coronary syndrome were analyzed. All patients had early coronary angiography following stabilization. Apart of 27 patients who had either medical treatment only or surgery 115 pts had PCI RESULT: Complications were reported in 19 out of the 115 pts who underwent PCI (16.5%%. They were; 1- Significant Coronary Artery dissection in 13 pts (11%}, 2- Signif. Coronary thrombi, 3 pts {3%) culminating in NSE-MI in two, 3- Signif. Creatine Kinase rise; NSE-AMI, 2 pts (2%), 4- Arterial Rupture and death 1 pt; 1%. These primary complications had led to Secondary complications in 9 pts and tertiary complications in six. Dissection, the most frequent primary complication had culminated in five of the ten infarcts (NSTE-AMI). B-Predictors of complications:- Complications rate was not affected by worsening of clinical severity of the various groups of pts while it was directly linked to the no. of risk factors. Their rates were zero, 12%, 15% and 33% in pts with no risk factor, 1 , 2, and 3-5 Risk Factors respectively The data of the 79 patients with one or two risk factors suggested that hypertension was associated with the highest rate of complications ;(27%). This was probably attributed to the finding in this study that Likelihood of sustaining dissection, the precursor of most complications, was more than twice frequent in the hypertensive pts compared to those without hypertension (18% compared to 8% respectively). CONCLUSION: Inhospital Complications of coronary intervention in patients with NSTE-ACS were in one sixth of patients (16.5%). Dissection was most common complication (11%). It had precipitated five of the eight cases of coronary thrombosis (63%) and five of the ten Acute myocardial Infarctions (50%). Complications had probably increased with the increment of the number of Risk Factors but they were not related to clinical severity. Hypertension probably was associated with highest complication rate, this might be due a possible association between dissection and hypertension and underlined the need for further study