Cardiovascular Journal of Africa: Vol 27 No 1 (January/February 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 1, January/February 2016 40 AFRICA
in all 172 patients (100.0%). There was no difference between
the groups in terms of age, diabetes, hypertension and smoking
status, and length of hospital stay. Average values were similar for
heart rate, and systolic and diastolic blood pressure. Creatinine
and troponin I values were higher in the TT group. No difference
was found between the groups with regard to blood glucose and
haemoglobin levels, and platelet count.
The StD time from the onset of symptoms to admission to
hospital was similar across the patients who had received similar
medical treatment. Average DtB duration was 20.2 minutes for
the PPCI group. DtN time was 23.2 minutes and StN time was
291.7 minutes in the TT group.
Although the mortality rate in the first month was higher in
the TT group, the difference was not statistically significant (p =
0.077). Re-MI and re-hospitalisation rates were similar between
the groups during the first month. There were more ventricular
tachycardia (p = 0.039) and ventricular fibrillation (p = 0.005)
cases in the TT group. Rate of atrioventricular block of at least
second degree, observed during the hospital stay, was similar.
Rates of TIMI 0 and TIMI I–II flow following PCI were similar
across the groups. The groups were similar in terms of SYNTAX
score, one of the indicators of extent and complexity of coronary
lesion (Table 1).
There was no difference between the two groups regarding RV
dimensions, volumes and function on admission to our hospital.
There was no difference between the two groups with regard to
the conventional RV systolic parameters, RV dimensions and
volumes at the one-month follow up. There was no difference
between the groups regarding the LVEF and LV-WMSI on
admission to hospital and at the one-month follow up (Table 2).
Echocardiographic changes between admission and
one-month follow up were investigated for the patients included
in the study groups. Mean values of each parameter were
significantly increased at the one-month follow up compared to
the early period within each individual group (Table 3).
2D-STE analysis of the RV revealed that the study groups
had similar RV-free-S and RV-free-SR levels in the early period
and at the one-month follow up (Tables 2, 3). According to
these results, the strain/strain rates of the RV segments in both
groups were significantly lower in the early period than those at
the one-month follow up. In addition, changes in the RV mean
strain/strain rates were significantly different (Table 3).
Table 1. General characteristics, cardiac complications and laboratory
results of the patients according to the study groups
Parameter
PPCI
(n = 132)
TT + PCI
(n = 78) p-value
Age (years) 64.3 (± 12.1) 62.9 (±10.2) 0.128
Diabetes mellitus, n (%) 25 (18.9) 21 (26.9) 0.120
Hypertension, n (%) 73 (55.3) 41 (52.6) 0.404
Current smoking, n (%) 64 (48.5) 47 (60.3) 0.066
Heart rate (beats/min) 61.8 (± 21.1) 63.9 (± 20.72) 0.480
SBP (mmHg) 123.9 (± 29.5) 128.6 (± 34.12) 0.292
DBP (mmHg) 75.1 (± 17.3) 78.4 (± 20.2) 0.206
Creatinine (mg/dl) 0.98 (± 0.39) 1.16 (± 0.83) 0.048
Peak troponin I (ng/dl) 61.7 (41.2–105.3) 88.3 (48.3–166.8) 0.006
Blood glucose (mg/dl) 151.4 (87.5–245.3) 164.5 (92.7–261.3) 0.251
Haemoglobin (mg/dl) 13.5 (± 1.9) 13.6 (± 1.7) 0.521
Platelets (103 /μl) 245.9 (± 59.9) 253.1 (± 53.3) 0.465
Clopidogrel, n (%) 132 (100) 78 (100) 1.000
Acetylsalicylic acid, n (%) 132 (100) 78 (100) 1.000
Beta-blocker, n (%) 108 (81.8) 60 (76.9) 0.247
Statin, n (%) 131 (99.2) 77 (98.7) 0.983
ACE/ARB, n (%) 118 (89.4) 66 (84.6) 0.131
Total mortality, n (%) 8 (6.1) 7(8.9) 0.557
VT, n (%) 18 (13.6) 19 (24.4) 0.039
VF, n (%) 3 (2.2) 9 (11.5) 0.005
High-degree AV block, n (%) 16 (12.1) 8 (10.2) 0.246
Post-PCI TIMI 0 flow rate, n (%) 3 (2.3) 1 (1.3) 0.618
Post-PCI TIMI I–II flow rate,
n (%)
9 (6.8) 4 (5.1) 0.643
Pre-PCI SYNTAX score 22.1 (± 8.8) 21.2 (± 21.1) 0.511
Post-PCI SYNTAX score 8.4 (± 8.6) 9.1 (± 7.2) 0.568
Intensive care unit (days) 3.58 ± 1.19 3.85 ± 2.21 0.252
Duration of hospital stay (days) 6.48 ± 3.17 7.03 ± 4.71 0.322
Symptom-to-door time (min) 285.9 ± 135.1 268.5 ± 141.8 0.577
Mortality in hospital, n (%) 6 (4.6) 5 (6.4) 0.108
Mortality rate after discharge
from hospital, n (%)
2 (1.5) 2 (2.5) 0.591
Re-MI after discharge from
hospital, n (%)
2 (1.5) 2 (2.5) 0.591
Re-hospitalisation, n (%) 4 (3.0) 3 (3.8) 0.856
ACE: angiotensin converting enzyme; ARB: angiotensin receptor blocker; AV:
atrioventricular; DBP: diastolic blood pressure; MI: myocardial infarction; PCI:
percutaneous coronary intervention; PPCI: primary percutaneous coronary inter-
vention; SBP: systolic blood pressure; DBP: diastolic blood pressure; TT: throm-
bolytic therapy; VT: ventricular tachycardia; VF: ventricular fibrillation.
Table 2. Right and left ventricular echocardiographic
parameters according to the groups
Parameter
First 12 hours (early period) First month after RV-STEMI
PPCI TT+PCI p-value PPCI TT+PCI p-value
RV basal (mm) 37.3 (± 4.4) 37.9 (± 5.1) 0.325 34.3 (± 6.1) 33.8 (± 7.4) 0.128
RV mid (mm) 31.8 (± 2.4) 31.2 (± 3.5) 0.240 26.9 (± 3.6) 27.5 (± 2.8) 0.838
RV longitudi-
nal (mm)
72.2 (± 5.4) 73.1 (± 2.4) 0.486 65.3 (± 2.4) 66.1 (± 2.4) 0.214
RV-eDV
indexed (ml/m2 )
64.3 (± 9.4) 63.2 (± 5.6) 0.082 56.9 (± 4.7) 57.1 (± 8.7) 0.762
RV-eSV
indexed (ml/m2 )
37.1 (± 4.3) 38.6 (± 3.9) 0.844 30.1 (± 2.9) 31.9 (± 3.0) 0.274
RVEF (%) 43.1 (± 8.3) 42.6 (± 8.8) 0.978 49.9 (± 7.2) 49.3 (± 7.2) 0.934
RV-FAC (%) 29.9 (± 7.4) 29.4 (± 7.4) 0.458 33.3 (± 6.8) 34.2 (± 6.8) 0.110
RV-TAPSE
(mm)
16.1 (± 4.0) 16.7 (± 4.2) 0.082 22.4 (± 3.8) 21.8 (± 3.9) 0.102
RV-MPI 0.49 (± 0.09) 0.50 (± 0.12) 0.648 0.41 (± 0.12) 0.40 (± 0.14) 0.365
RV-IVA (m/s2) 2.24 (± 0.64) 2.31 (± 0.52) 0.121 2.99 (± 0.63) 2.90 (± 0.55) 0.071
RV-S′ (cm/s) 9.1 (± 1.7) 9.5 (± 1.1) 0.212 11.3 (± 3.2) 10.9 (± 3.2) 0.094
RV apical
strain (%)
–9.7 (± 1.8) –10.1 (± 1.5) 0.286 –16.6 (± 2.9) –15.9 (± 2.1) 0.293
RV mid strain
(%)
–14.1 (± 2.3) –14.9 (± 1.9) 0.351 –22.6 (± 3.6) –21.2 (± 2.1) 0.102
RV basal strain
(%)
–18.2 (± 4.7) –17.6 (± 2.0) 0.422 –24.8 (± 4.1) –24.2 (± 2.1) 0.434
RV free strain
(%)
–14.0 (± 2.7) –14.2 (± 1.7) 0.429 –21.3 (± 3.3) –20.4 (± 3.7) 0.102
RV apical
strain rate (1/s)
–0.8 (± 0.4) –0.9 (± 0.3) 0.424 –1.5 (± 0.5) –1.4 (± 2.1) 0.624
RV mid strain
rate (1/s)
–1.1 (± 0.6) –1.0 (± 0.5) 0.435 –2.2 (± 0.4) –2.1 (± 2.1) 0.743
RV basal strain
rate (1/s)
–1.7 (± 0.6) –1.6 (± 0.4) 0.515 –2.3 (± 0.5) –2.2 (± 2.1) 0.802
RV free strain
rate (1/s)
–1.2 (± 0.4) –1.2 (± 0.5) 0.512 –2.0 (± 0.4) –1.9 (± 0.6) 0.292
LVEF (%) 49.3 (± 8.3) 48.4 (± 7.6) 0.094 52.2 (± 6.6) 51.9 (± 8.3) 0.498
LV-WMSI 1.48 (± 0.27) 1.52 (± 0.34) 0.413 1.16 (± 0.25) 1.21 (± 0.31) 0.128
eDV: end-diastolic volume; EF: ejection fraction; eSV: end-systolic volume; FAC:
fractional area change; IVA: isovolumic acceleration; LV: left ventricle; MPI: myocar-
dial performance index; RV: right ventricle; S′: tissue Doppler systolic wave; TAPSE:
tricuspid annulus planimetric systolic excursion; WMSI: wall motion score index.