Outcome of Primary Percutaneous Coronary Intervention (PCI)
of Ostial versus Nonostial Occlusion of Left Anterior
(Study conducted at National Institute of Cardiovascular Diseases, Karachi)Muhammad Tariq Farman, Naveed Ullah Khan, Jawaid Akbar Sial, Tahir Saghir,
Tariq Masood, Syed Nadeem Hasan Rizvi, Khan Shah Zaman.
OBJECT: The object of this study was to compare the outcome of Primary PCI of ostial versus non ostial occlusion of LAD artery.
MATERIALS AND METHODS: This observational study was conducted at National Institute of Cardiovascular Diseases Karachi, Pakistan from January 1st, 2008 to December 31st, 2008. A total of 70 patients presented to the catheterization laboratory for Primary PCI of LAD artery in whom baseline coronary angiogram showed acute occlusion of left anterior descending artery were enrolled for the study. All Patients received Aspirin, Clopidogrel and Platelet Glycoprotein IIB IIIA inhibitor. Patients were followed at one month, 3 months and 6 months.
RESULTS: Out of 70 cases 50 had nonostial and 20 had ostial occlusion. Baseline characteristics were similar between both groups. Stenting was done in 95% of all patients and was similar in patients with ostial or nonostial narrowing. Procedural success was the same for ostial and nonostial Primary PCI (100% vs. 96%). Six months event free survival was also similar in both groups (75% vs. 76%). Total event rate and mortality was also same in both groups (25% vs. 24% and 10% vs. 10%).
CONCLUSION: Primary PCI of ostial LAD occlusion with suitable anatomy is as safe and similar as non ostial LAD occlusion and optimal results can be achieved in this high risk group of patients in a developing country at a tertiary care public sector hospital. To validate our results further studies with larger cohort are needed.
ST-segment elevation, Myocardial Infarction, Primary Percutaneous Coronary Intervention, Ostial Left anterior descending artery, stenting.