Comparison of the clinical characteristics and in hospital outcomes of proximal versus non-proximal lesions in dominant right coronary artery ST-elevation myocardial Infarction

Tue, 29 Oct 2024 00:00:00 +0000

Background: Right coronary artery (RCA) ST-elevation myocardial infarction (STEMI) is a critical cardiovascular condition that can lead to significant morbidity and mortality if not treated promptly. Primary percutaneous coronary intervention (PCI) is the gold standard for managing STEMI patients. The objective of this study is to evaluate clinical characteristics and outcome of proximal versus non-proximal, in dominant “right coronary artery (RCA) ST-elevation myocardial infarction (STEMI)” patients undergoing primary PCI at NICVD, Karachi.

Methodology: This retrospective comparative cross-sectional study included equal number of consecutive patients diagnosed with dominant “RCA STEMI” with culprit proximal and non-proximal lesions undergoing primary PCI. In-hospital clinical outcomes including mortality, heart failure, cardiogenic shock, ventricular arrhythmias, myocardial infarction, stent thrombosis, AV block, TPM placement, IABP placement, and other procedure-related complications were compared between the two groups.

Results: Total 355 patients each with proximal lesions and non-proximal lesions were included. Age was similar between the two groups, with no significant difference observed (56.9 ± 10.8 years vs. 56 ± 10.4 years; p = 0.367). Pre-procedure TIMI flow was significantly worse in the proximal lesion group compared to the non-proximal lesion group (TIMI 0: 70.1% vs. 66.8%; p = 0.015). Delay in PCI was noted for 107 (30.2%) vs. 68 (19.2%); p=0.001in proximal compared to the non-proximal group, respectively.

Conclusion: Proximal lesions appear to be associated with poorer initial coronary blood flow and a higher likelihood of in-hospital mortality. Further, a significant delay in intervention was observed for proximal group. Hence, these findings revealed the importance of timely intervention and tailored management strategies based on lesion location in optimizing outcomes for STEMI patients.

A Needle in a Haystack: uncovering RV branch compromise after primary PCI of RCA via ECG

Maryum Masoud — Tue, 29 Oct 2024 00:00:00 +0000

Background: ECG remains the mainstay of diagnosis of STEMI in clinical practice and proper interpretation helps to identify the culprit artery. We present a rare case in which ST elevation in ECG proved to be quite misleading.

Case Presentation: We present the case of an elderly male patient who presented to emergency department with acute onset of severe chest pain. Ecg done in emergency department which showed inferior wall myocardial infarction (MI) complicated by complete heart block. He underwent angioplasty of right coronary artery. Patient in CCU developed ST elevation in anterior chest leads which was attributed to RV branch occlusion.

Management and Results: Patient was managed medically as he was pain free and hemodynamically stable. Serial ECG’s done. He was strictly monitored in CCU for any hemodynamic or electrical instability. Patient remained pain free throughout his stay in CCU. After 6 to 8 hours ST segment elevation completely settled down with no Q wave formation.

Conclusion: ST segment elevation in anterior leads is hallmark of anterior wall MI. Interestingly, isolated right ventricle MI can also produce similar changes in ECG. Very few case reports found on management of isolated RV branch occlusion and patient can present with a wide spectrum of clinical presentation from being completely asymptomatic to suffering from cardiac arrest. Management of isolated RV branch occlusion is another dilemma and it can vary from case to case.

Pakistan Journal of Cardiovascular Intervention

Comparison of the clinical characteristics and in hospital outcomes of proximal versus non-proximal lesions in dominant right coronary artery ST-elevation myocardial Infarction

A Needle in a Haystack: uncovering RV branch compromise after primary PCI of RCA via ECG