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

Abstract

Thirty-day mortality was high in patients presenting with an ULMCA-related AMI, both in the PCI as in the CABG-treatment group. Presentation with cardiogenic shock, TIMI 0/1 flow on initial angiogram and diabetes mellitus were independently predicting of 30-day mortality, whereas treatment allocation was primarily determined by presentation with TIMI 0/1 flow.

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

“…In a study comparing outcomes after percutaneous or surgical revascularisation of ULMCA-related AMI by Grundeken et al, the 30-day mortality rates of the PCI and CABG groups were 64% and 24%, respectively. (17) However, in Grundeken et al's study, there was an obvious bias regarding the selection of revascularisation strategy: for patients with TIMI Grade 0 or 1 in angiography, PCI was preferred over CABG. (17) The 2011 guideline for PCI from the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), and Society for Cardiovascular Angiography and Interventions also pointed out that for STEMI in which distal coronary flow was TIMI Grade < 3, PCI can be performed more rapidly and safely than CABG (class IIa recommendation).…”

“…(17) However, in Grundeken et al's study, there was an obvious bias regarding the selection of revascularisation strategy: for patients with TIMI Grade 0 or 1 in angiography, PCI was preferred over CABG. (17) The 2011 guideline for PCI from the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), and Society for Cardiovascular Angiography and Interventions also pointed out that for STEMI in which distal coronary flow was TIMI Grade < 3, PCI can be performed more rapidly and safely than CABG (class IIa recommendation). (18) Marso et al reported that the mortality during hospitalisation in the balloon angioplasty-only group (70%) and the stenting group (35%) differed significantly, proposing that stent implantation could improve the prognosis.…”

Thirty Years Later: Evolution of Treatment for Acute Left Main Coronary Artery Occlusion

“…Acute occlusion of the left main coronary artery is usually a fatal event, yet 4% of patients that arrive with STEMI and undergo PCI are reported to have left main narrowing and occlusion [5–8]. Reports of survival after acute total occlusion of left main coronary artery were rare prior to the thrombolytic era and therefore the report of the patient we treated in 1982 was published.…”

Percutaneous coronary intervention for acute myocardial infarction due to unprotected left main coronary artery occlusion

“…In a retrospective study, 55 patients underwent PCI (69% in cardiogenic shock) and 29 underwent CABG (28% in cardiogenic shock) for STEMI (78% PCI, 58% CABG) and NSTEMI/complete left bundle branch block with ULMCA culprit lesions . The PCI group had a higher prevalence of TIMI grade 0 flow (44% vs. 0%).…”

“…A multivariate analysis showed that three factors were independent predictors of treatment allocation between PCI and CABG: TIMI 0/1 flow, distal bifurcation disease, and year of inclusion into the study . After excluding those with TIMI 0/1 flow, patients were more likely to undergo primary PCI if they had cardiogenic shock, and more likely to undergo CABG if they had distal ULMCA disease.…”