Complete and Incomplete Revascularization of patients with Non-ST-Elevation Acute Coronary Syndrome using Angioplasty and Stenting.

Abstract

Background: Angioplasty and stenting; Percutaneous coronary intervention (PCI) has become important tool of Reascularizing patients with stable angina and Acute ST-Elevation Myocardial Infarction, while their role in Non ST-elevation Acute coronary syndrome is expanding.

Objestives: The aim was to study the outcome of complete and incomplete Revascularization, by PCI, of pts with NSTE-ACS, and the effect of the traditional risk factors and their relation to the number of stents.

Patients and Methods:- After stabilization 115 out of 142 consecutive hospital admissions with Non St-Elevation Acute Coronary Syndrome were revascularized Percutanously. 

Results:-Apart from two pts, who had advanced disease, PCI had succeeded in reascularizing the remaining 113 pts, (98%); 93 of them had Complete revascularization (81%) with elimination of all stenotic lesions, while 20 pts had Incomplete Revascularization The later consisted of fifteen Patients who had dilatation of the culprit lesion/s only (group a) and 5 pts who had dilatation of all lesions except uncrossable lesion/s despite painstaking attempts (group b). cardiac events:-Five of the 93 pts with complete revascularization (5.4%) had Major Cardiac Events compared to 4 of the 15 pts in group a; Culprit-lesion-only Revascularization (27%), suggesting that leaving behind angioplastable lesion/s might not be feasible, yet the sample is small. Risk Factors:- The likelihood of achieving Complete Revascularization was inversely linked the no. of risk factors. It had dropped from 100%, to 85%, 79%, and 67% in pts with nil, 1, 2, and 3-5 Risk Factors respectively. Conversely the no. of stents deployed was directly linked to the number of Risk Factors reflecting a more severe underlying disease.

Conclusion: Early PCI in had achieved complete revascularization of 81% of pts with NSTE-ACS. Complete Revascularization was associated with much lower Major Cardiac events than Revascularization of the Culprit lesion only. Frequency of Complete revascularization had proportionately increased with the no. risk factors reaching 100% in without risk factors (100%). The no. stents had proportionately increased with the no. of Risk factors suggesting more severe underlying disease.