BACKGROUND: The leading cause of mortality in the country is heart disease with a rate of 94.5 deaths per 100,000 Filipinos. Multi-vessel coronary artery disease (MV-CAD) patients carry an increased procedural risk especially those with increased lesion complexity or unfavorable anatomy.
OBJECTIVE: The study aims to determine the variables that will predict procedural success and clinical outcome among MV-CAD patients undergoing percutaneous coronary intervention
SETTING: Philippine Heart Center, Quezon City, Philippines
METHODOLOGY: This retrospective cohort study obtained data from the four-year Philippine Heart Center Registry consisting of 1,030 patients who underwent Multi-Vessel Percutaneous Coronary Intervention (MVPCI) from January 2009 to January 2012 at the Cardiac Catheterization Laboratory.
RESULTS: Significant predictors for improved procedural success and reduced risk for major cardiovascular events was evident in male patients, those with mild diastolic dysfunction (grade I or II) and patients on statin therapy. The variables with unfavorable procedural and clinical outcome are female patients, those with unstable angina, STEMI, heart failure, COPD, the need for IABP counterpulsation and a left main artery coronary lesion.
CONCLUSION: The results reflect a local "real-life scenario" providing important information on the predictors of outcome among Filipino patients with multi-vessel disease undergoing percutaneous coronary intervention. The information obtained is clinically relevant for both cardiologist and interventionist providing an important risk stratification and contributing to the holistic delivery of cardiovascular care.

Human ; Male ; Female ; Middle Aged ; Coronary Artery Disease ; St Elevation Myocardial Infarction ; Percutaneous Coronary Intervention ; Angina, Unstable ; Heart Failure ; Cardiac Catheterization ; Pulmonary Disease, Chronic Obstructive

Introduction: Single coronary artery and coronary artery fistulas are unusual findings either alone or in combination. They may be incidental findings or can present with myocardial ischemia. Case Presentation: A 46-year-old male had chest pain accompanied by heart failure symptoms. He sought consult in our institution where further workups revealed that he suffered an acute coronary syndrome. He underwent diagnostic coronary angiogram which showed significant coronary artery disease. There was also a single coronary artery with a coronary artery fistula. Patient was appraised regarding surgical revascularization and repair but did not consent. He was stabilized and improved on optimal anti ischemic therapy. Discussion: Electrocardiogram revealed ST elevation myocardial infarction of the anterior wall. Two dimensional echocardiogram showed depressed systolic function with an ejection fraction of 48% and multisegmental wall motion abnormalities. Coronary angiogram revealed a 70-80% stenosis of the mid portion of the left anterior descending artery. There is a fistulous vessel draining to the main pulmonary artery. The left circumflex is super dominant with an 80-90% stenosis at its termination and supplying the right coronary circulation. The right coronary artery was absent. Conclusion Coronary artery fistula in combination with a congenitally absent coronary artery is extremely rare. The presence of these abnormalities alone or in combination can exacerbate ischemia, complicate pre existing coronary artery disease and may cause ischemic cardiomyopathy. This case emphasizes the importance of integration of clinical as well as imaging modalities to diagnose this uncommon abnormality and in guiding clinicians for definitive management.