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

Background: Armand Trousseau (1801-1865) stated that an unexpected or migratory thrombophlebitis could be a forewarning of an occult visceralmalignancy.1 The classical manifestations of Troussseau's syndrome are caused by venous thrombosis, nonbacterial thrombotic endocarditis often in conjunction with arterial embolization and arterial thrombosis.Setting: St. Luke's Medical Center, Quezon City, PhilippinesCase: We report here a case of a 67-yearold male with multiple strokes as the initial presentation of a pancreatic malignancy. He had a three-month history of epigastric pain and had two strokes in a span of one month, with multiple infarcts in both hemispheres, anterior and posterior circulation. A large silent pancreatic mass was seen on abdominal CT scan measuring 4.4 x 3.7 cm. On the 30th hospital day, patient had his third stroke, withsevere disability, Modified Rankin Scale8 (MRS) grade of 5 and NIHSS of 22.Diagnostics: Cranial MRI showed multiple recent infarcts in both cerebral and cerebellar hemispheres without confirmation to a vascular territory. Thereis stenosis of both anterior and middle cerebral artery and right posterior cerebral artery. Elevated transaminases and alkaline phosphatase, conjugatedhyperbilirubinemia, hypoalbuminemia, and deranged bleeding parameters were noted. A non-contrast abdominal CT scan showed a soft density at thepancreatic tail measuring 4.4x3.7 cm, with multiple hypodensities seen in the liver and spleen.Conclusion: Stroke as the initial manifestation of a pancreatic malignancy is rare. However, in patients with repeated strokes and a steep downhill course, this should prompt further investigation such as a possible underlying malignancy.
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