Speckle Tracking Echocardiography as A Predictor of in Hospital Major Adverse Cardiovascular Events in STEMI Patient Treated with Primary PCI Strategy Versus Pharmacoinvasive PCI Versus Rescue PCI
Keywords:
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Background: Primary percutaneous coronary intervention (PCI) is considered the best method of reperfusion in the setting of acute ST elevation myocardial infarction (STEMI). Logistics sometimes make a hindrance to this strategy in developing countries. Thrombolytic therapy strategy, whereby the patient receives a fibrinolytic agent and subsequently taken up for coronary angiogram within 3–24 h
of successful thrombolysis or immediately if thrombolytic therapy failed is considered an alternative method for reperfusion. This work aimed to study and assess how speckle tracking can predict in hospital major adverse cardiovascular events (MACE) in patients treated with Primary PCI versus pharmacoinvasive strategy versus rescue PCI. Methods: This study was conducted on 90 patients admitted with STEMI within the first 24 hours. Exclusion criteria included previous PCI, patients with history of CABG, patients with cardiogenic shock, and patients with renal or hepatic failure, malignancy, rheumatic or congenital heart disease. Patients were divided into 3 groups: Group I: 40 patients subjected to primary PCI, group II: 30 patients subjected to Rescue PCI, and Group III: 20 patients subjected to Pharmacoinvasive PCI. 2D speckle tracking echocardiography was done to the three groups. Results: There was a statistically significant difference between the three groups in MACE, and Global longitudinal strain (GLS). There was a statistically significant association between GLS and MACE in the three groups. In univariate regression analysis: Final TIMI flow< III,
ejection fraction (EF), end systolic diameter (ESD)m end diastolic diameter (EDD), GLS, and primary PCI mode of treatment were predictors of MACE. In the multivariate regression analysis, using model adjusted for aforementioned parameters: GLS was a predictor of MACE. Conclusions: It was evident that GLS was a good predictor of MACE. Patients with higher GLS had increased incidence of
MACE. It was also evident that GLS was higher in patients with rescue PCI when compared to primary PCI and pharmacoinvasive group.