Acute myocardial infarction due to left main coronary artery disease in men and women: does ST-segment elevation matter?

Abstract

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.

Determinants of In-Hospital Death in Acute Myocardial Infarction With Triple Vessel Disease

“…3) Acute myocardial infarction related to the left main trunk was defined as stenosis over 50% or total occlusion in a left main coronary artery. 9) Chronic total occlusion (CTO) was defined as a 100% luminal narrowing in a non-IRA before percutaneous coronary intervention (PCI) without antegrade flow and with antegrade or retrograde filling by collateral vessels. 2,10) Peripheral arterial disease (PAD) was defined as an ankle brachial index (ABI) < 0.9.…”

Two-Year Outcomes after Left Main Coronary Artery Percutaneous Coronary Intervention in Patients Presenting with Acute Coronary Syndrome

“…ACS patients with significant unprotected LMCA disease represent one of the most high-risk types of coronary artery disease, especially for patients with acute MI caused by LMCA culprit lesion. As LMCA supplies blood perfusion for the majority of left ventricle myocardium regardless of coronary artery dominance, acute LMCA infarction leads to large infarction area [26]. A large proportion of AMI patients with LMCA involvement present cardiogenic shock, who are at much higher risk of in-hospital and short-term mortality [27].…”

MiR-324/SOCS3 Axis Protects Against Hypoxia/Reoxygenation-Induced Cardiomyocyte Injury and Regulates Myocardial Ischemia via TNF/NF-κB Signaling Pathway

“…5) With the development of percutaneous coronary intervention, undergoing urgent and successful revascularization of the coronary artery becomes the main therapy method for patients with MI. [6][7][8] However, patient outcome is still undesirable. Therefore, seeking for some new therapy strategies for the treatment of MI is necessary.…”