Comparison of Clinical Outcomes between the Ostial Versus Non-Ostial Culprit in Proximal Left Anterior Descending Artery Acute Myocardial Infarction

Abstract

Percutaneous coronary interventions to the proximal left anterior descending artery (pLAD)-acute myocardial infarction (AMI) are still challenging, especially in the ostial pLAD. Clinical outcomes of the ostial pLAD-AMI were not well investigated. The aim of the present study was to compare clinical outcomes of the ostial pLAD-AMI with those of the non-ostial pLAD-AMI. The primary endpoint was the major cardiovascular events (MACE), defined as the composite of cardiac death, AMI, stent thrombosis (ST), target lesion revascularization (TLR), and target vessel revascularization (TVR). Between January 2009 and March 2016, a total of 401 pLAD-AMI were included as the study population and were divided into 78 ostial pLAD-AMI (the ostial pLAD group), and 323 non-ostial pLAD-AMI (the non-ostial pLAD group). The median follow-up duration was 414 days. The MACE tended to be higher in the ostial pLAD group (8.0% at 30 days, 19.9% at 400 days) than in the non-ostial pLAD group (4.4% at 30 days, 12.9% at 400 days) without reaching statistical significance (P = 0.087). The prevalence of cardiac death was significantly higher in the ostial pLAD group (6.6% at 30 days, 9.5% at 400 days) as compared with the non-ostial pLAD group (3.1% at 30 days, 4.5% at 400 days) (P = 0.034). There were no significant differences in ST, AMI, TLR, or TVR. We concluded that, as compared with the non-ostial pLAD-AMI, the clinical outcomes of the ostial pLAD-AMI, especially cardiac death, tended to be worse, requiring special attention to the ostial pLAD-AMI.

Appetite Predicts Clinical Outcomes in High Risk Patients Undergoing Trans-Femoral TAVI

“…Diabetes mellitus (DM) was defined as hemoglobin A1c (HbA1c) > 6.5% (national glycol-hemoglobin standardization program (NGSP) value) or medical treatment for DM. 10,11) Malignant diseases included a current malignancy or history of malignancy. Estimated glomerular filtration rate (eGFR) was calculated by modification of diet in renal disease (MDRD) method adjusted for the Japanese population.…”

Comparison of Postcatheterization Pseudoaneurysm between Brachial Access and Femoral Access

“…12) Dyslipidemia was defined as a total cholesterol level of !220 mg/dL or a low-density lipoprotein cholesterol level of !140 mg/dL or medical treatment for dyslipidemia or a history of dyslipidemia. 12,13) Diabetes mellitus was defined as a hemoglobin A1c level of !6.5% (as NGSP value) or medical treatment for diabetes mellitus or a history of diabetes mellitus. 12) We also calculated the estimated glomerular filtration rate (eGFR) from the serum creatinine level, age, weight, and gender using the following formula: eGFR = 194 × Cr −1.094 × age −0.287 (male), eGFR = 194 × Cr −1.094 × age −0.287 × 0.739 (female).…”

Determinants of Improvement of Mid-term Ejection Fraction in Patients with Acute Myocardial Infarction

“…Definition: The diagnosis of AMI required the following criteria: symptoms consistent with AMI; elevated cardiac enzymes, including Troponin T, Troponin I, and/or creatinine kinase (at least two-fold increase from the normal upper limit); and ST-segment elevation or depression in electrocardiograms compatible with AMI. [13][14][15] Diagnostic ST elevation was defined as a new ST elevation at the J point in at least two contiguous leads of 2 mm (0.2 mV), and others were defined as not an ST elevation. 3) Hypertension was defined as a medical treatment for hypertension and/or a history of hypertension before admission.…”