Cardiovascular diseases are currently the leading cause of death in industrialized countries and are expected to become so in emerging countries by 2020.
Registry data consistently show that NSTE-ACS (Non ST elevation-Acute coronary syndrome) is more frequent than STE-ACS (ST elevation- Acute coronary syndrome) the annual incidence is about 3 per 1000 inhabitants, but varies between countries.
Hospital mortality is higher in patients with STEMI (ST elevation myocardial infarction) than among those with NSTE-ACS (7% vs. 3.5%, respectively), but at 6 months the mortality rates are very similar in both conditions (12% and 13% respectively) Long-term follow-up showed that death rates were higher among patients with NSTE-ACS than with STE-ACS, with a two-fold difference at 4 years.
There has been a debate about whether early angiography followed by revascularization is associated with an early hazard.
This study was carried out on 90 patients presented to cardiology department at Benha University Hospital & Wadi El Nil Hospital and they were divided into three groups:
Group (1): 30 patients with immediate coronary intervention (within 4 hours after stabilization of chest pain and clinical condition).
Group (2): 30 patients with coronary intervention in the period from 4-24 hours after stabilization of chest pain and clinical condition.
Group (3): 30 patients with coronary intervention within the period from 24-72 hours after stabilization of chest pain and clinical condition.
The exclusion criteria were, persistent ST elevation in ECG, age less than 18 years or more than 90 years, hemodynamic instability, overt congestive heart failure, cardiogenic shock, high bleeding risk & angiographically not suitable for PCI.
All the studied groups were subjected for full history taking with stress on; age, gender, history of previous myocardial infarction or coronary intervention, family history of coronary artery disease, diabetes mellitus, hypertension, complete clinical examination, resting (12) leads surface ECG searching for; rate, rhythm, left ventricular hypertrophy changes and ischemic changes, plain x-ray chest searching for signs of heart failure and cardiac enzymes; CTnI or T & CK-MBtrans-thoracic echocardiography on admission & 30 days after coronary intervention.
PCI was done according to the standard technique, through femoral approach, using XB guiding catheter or JL or JR according to the target vessel and its anatomy. Stent type, length and diameter were determined by the operator, sheath removed about 6 hours after the procedure and compression done manually.
The study had found that there was no significant statistical difference between groups of study as regard, reinfarction, heart failure, stroke, recurrent ischemia, arrhythmia, major bleeding, minor bleeding, urgent intervention & death during hospital admission.
The study had found also that following-up of the patients of interest for 30 days after doing coronary intervention did not show any significant statistical difference as regard angina requiring hospitalization, reinfarction, TVR, heart failure, major bleeding, minor bleeding , death & mean EF.
This study had concluded that in NSTEMI an immediate invasive approach does not offer an advantage over an early or a selective invasive approach which is supported by similar clinical outcomes between groups of study.
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