IntroductionGender-specific issues regarding ST-segment elevation (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) due to unprotected left main coronary artery (ULMCA) disease were not sufficiently studied. We assessed the value of STEMI/NSTEMI initial classification on the management of men and women with acute MI due to critical stenosis or occlusion of the ULMCA.Material and methodsThe study group consisted of 643 consecutive patients with acute MI with the ULMCA as the infarct-related artery. Data derive from an ongoing, nationwide, multicenter, prospective, observational registry.ResultsIsolated ULMCA disease was more frequent in women and multivessel disease was more frequent in men in the NSTEMI group. The incidence of cardiogenic shock or pulmonary edema and cardiac arrest was higher in the STEMI group. Totally occluded ULMCA was more frequent in the STEMI group. Although the majority of patients underwent percutaneous coronary intervention (PCI), it was less frequently used in NSTEMI women and NSTEMI men. Although in-hospital and long-term mortality rates were higher in the STEMI group, there were no gender-related differences within groups. The initial ST-segment elevation was an independent predictor of in-hospital (OR = 2.37, 95% CI: 1.14–4.91, p = 0.02) and 12-month (OR = 1.52, 95% CI: 1.01–2.27, p = 0.045) mortality.ConclusionsThere were no gender-related differences in the management within the STEMI or NSTEMI group. Although acute myocardial infarction due to ULMCA disease is associated with high mortality in both genders, STEMI was a negative prognostic factor of in-hospital and 12-month mortality. Despite poor baseline characteristics and clinical presentation in women, female gender itself did not influence mortality.

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(Cardiol J 2013; 20, 2: 190-196)

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Right-side CRT implantation procedure is considered more technically demanding starting with venous access. The presence of a valve located in the ostium of only one visible lateral vein in flebography significantly limits the final success of CRT implantation. In cases where the standard technique of accessing the lateral vein while occluding in ostium by valve has failed, there is a possibility of using non-standard tools such as coronary catheters as subselectors to facilitate the success of the procedure.