Clinical outcomes after PCI for acute coronary syndrome in unprotected left main coronary artery disease: insights from the Swiss Acute Left Main Coronary Vessel Percutaneous Management (SALVage) study

Abstract

Acute coronary syndrome due to critical ULM stenosis is associated with high mortality even after successful PCI. Patients presenting with CS or STEMI are at particular risk.

Clinical outcomes after percutaneous or surgical revascularisation of unprotected left main coronary artery-related acute myocardial infarction: a single-centre experience

“…Reviewing the literature, there is a worldwide variety in the management of PPCI of ULMCA concerning drug-eluting stent (DES) or bare metal stent (BMS) use. Most of the contemporary European, Australian and Japanese studies reported dominant BMS8 17 or mixed BMS/DES1 3 16 18 21 use, while in the Korean studies, most PPCIs of the ULMCA were performed with DES 9 14 19. Previous large meta-analyses comparing DES with BMS in patients with stable angina/acute coronary syndromes38 and STEMI39 consistently showed no benefit of DES concerning death or MI, whereas revascularisation rates were significantly lower with DES.…”

Long-term prognosis of patients with acute myocardial infarction due to unprotected left main coronary artery disease: a single-centre experience over 14 years

“…(8) Collateral flow was graded using a classification system developed by Rentrop et al (9) ULMCA disease was defined as a lesion ≥ 50% in the left main artery in the absence of a patent coronary artery bypass graft (CABG) to the left anterior descending (LAD) or circumflex arteries. (10,11) CS was defined as hypotension secondary to cardiac dysfunction (i.e. systolic blood pressure of < 90 mmHg for at least 30 minutes or the need for supportive measures to maintain a systolic blood pressure of ≥ 90 mmHg) and end-organ hypoperfusion.…”

Outcomes of primary percutaneous coronary intervention in acute myocardial infarction due to unprotected left main thrombosis: The Asia‐Pacific Left Main ST‐Elevation Registry (ASTER)

“…These recommendations excluded patients presenting acutely with myocardial infarction. Acute coronary syndromes from culprit unprotected left main (ULM) critical stenosis has been associated with significant mortality and morbidity, due to the large area of myocardium at risk . In particular, the subset of ULM acute coronary syndrome (ACS) patients who survive the initial moments following ULM plaque rupture and actually enter the healthcare system with ST elevation myocardial infarction (STEMI) represent a much higher risk cohort with increased adverse outcomes …”