Date of Award

10-2018

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Masood Nadir

Second Advisor

Javed Tai

Third Advisor

Iqbal Azam

Department

Community Health Sciences

Abstract

Introduction: Repeat revascularization is considered as a significant adverse outcome due to failure of the prior revascularization via Percutaneous Coronary Intervention (PCI). Advancement related to techniques and adjunct pharmacological therapy has enhanced outcomes post-angioplasty. Still 10-12% of the patients undergoing PCI require repeat revascularization annually. Its risk factor profile is studied less in tertiary care settings of Karachi which require further investigations to predict and reduce the incidence of repeat revascularization. The objective of the study is to determine the factors associated with repeat Revascularization among adults aged 25 years and above within 5 years of index Percutaneous Coronary Intervention in tertiary care hospital in Karachi.
Method: This study was conducted at the Aga Khan University Hospital, Karachi. A Matched Case-Control study was conducted with 1:2 cases to controls ratio; matched on the variable time of undergoing initial PCI. A total 120 cases with repeat revascularization and 240 controls without revascularization were identified from Hospital Information Management Services (HIMS) department. The data was collected through medical record abstraction from the year 2011 till 2017.Data was analyzed using Multiple Conditional Logistic Regression to assess the association between patient and clinical related factors, and occurrence of repeat revascularization.
Results: The mean age was 61.49 k 10.32years. Around 70% of the total study participants were male and 80% of the total study population was overweight or obese. A higher number of participants were smokers and ex-smokers among cases as compared to controls (18.9% vs. 10% and 21.1 % vs. $- 15% respectively). Among clinical characteristics, one fifth of the cases had poor glycemic control than control group (23.3% vs. 12.2%). More patients were pre-diabetic in controls than in cases (16.11% vs. 7.78%). Results of multivariable conditional logistic regression showed that smoking status, health coverage and stent diameter were significantly associated with repeat revascularization. Moreover, there was 2% lower chance of repeat revascularization with 1 kilogram increase in weight. There was 3% lower chance of repeat revascularization with 1 year Increase in age.
Conclusion: In order to reduce the risk of complications post-angioplasty including repeat revascularization, the study findings suggest to aim targeted interventions for smoking cessation, maintaining optimal level of weight and appropriate selection of stent diameter in these patients. These findings also suggest future efforts for large scale, multi-center studies considering factors pertinent to lifestyle during follow-up visits to predict and prevent the disease progression and incidences of repeat revascularization post-angioplasty.

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1

Last Page

62

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