One-year Outcomes in Patients with ST-segment Elevation Myocardial Infarction Caused by Unprotected Left Main Coronary Artery Occlusion Treated by Primary Percutaneous Coronary Intervention

Abstract

Background:Very few data have been reported for ST-segment elevation myocardial infarction (STEMI) caused by unprotected left main coronary artery (ULMCA) occlusion, and very little is known about the results of this subgroup of patients who underwent primary percutaneous coronary intervention (PCI). The aim of this study was to determine the clinical features and outcomes of patients with STEMI who underwent primary PCI for acute ULMCA occlusion.Methods:From January 2000 to February 2014, 372 patients with STEMI caused by ULMCA acute occlusion (ULMCA-STEMI) who underwent primary PCI at one of two centers were enrolled. The 230 patients with non-ST-segment elevation MI (NSTEMI) caused by ULMCA lesion (ULMCA-NSTEMI) who underwent emergency PCI were designated the control group. The main indexes were the major adverse cardiac events (MACEs) in-hospital, at 1 month, and at 1 year.Results:Compared to the NSTEMI patients, the patients with STEMI had significantly higher rates of Killip class≥III (21.2% vs. 3.5%, χ2 = 36.253, P < 0.001) and cardiac arrest (8.3% vs. 3.5%, χ2 = 5.529, P = 0.019). For both groups, the proportions of one-year cardiac death in the patients with a post-procedure thrombolysis in myocardial infarction (TIMI) flow grade<3 were significantly higher than those in the patients with a TIMI flow grade of 3 (STEMI group: 51.7% [15/29] vs. 4.1% [14/343], P < 0.001; NSTEMI group: 33.3% [3/9] vs. 13.6% [3/221], P = 0.001; respectively]. Landmark analysis showed that the patients in STEMI group were associated with higher risks of MACE (16.7% vs. 9.1%, P = 0.009) and cardiac death (5.4% vs. 1.3%, P = 0.011) compared with NSTEMI patients at 1 month. Meanwhile, in patients with ULMCA, the landmark analysis for incidences of MACE and cardiac death was similar between the STEMI and NSTEMI (all P = 0.72) in the intervals of 1–12 months. However, patients who were diagnosed with STEMI or NSTEMI had no significant difference in reinfarction (all P > 0.05) and TVR (all P > 0.05) in the intervals of 0–1 month as well as 1 month to 1 year. The results of Cox regression analysis showed that the differences in the independent predictors for MACE included the variables of Killip class ≥ III and intra-aortic balloon pump support for the STEMI patients and the variables of previous MI, ULMCA distal bifurcation, and 2-stent for distal ULMCA lesions for the NSTEMI patients.Conclusions:Compared to the NSTEMI patients, the patients with STEMI and ULMCA lesions still remain at a much higher risk for adverse events at 1 year, especially on 1 month. If a successful PCI procedure is performed, the 1-year outcomes in those patients might improve.

Primary Angioplasty in a Catastrophic Presentation: Acute Left Main Coronary Total Occlusion—The ATOLMA Registry

“…In the present study, a lower incidence was found (0.58%). The discrepancy is related to the fact that previous studies also included subtotal occlusion or critical stenosis of the LMCA, while in this cohort, exclusively, patients with a true ATOLMA referred to primary angioplasty were recruited [ 4 , 6 – 8 , 10 , 11 , 16 ].…”

“…All except one patient presented Killip class III-IV, which reflect the poor clinical status of these patients at presentation. ATOLMA should be suspected in patients with STEMI accompanied by these potentially devastating presentations, and an early invasive strategy should be encouraged in these patients [ 3 , 6 , 8 ].…”

“…A more contemporary approach using new-generation stents, haemodynamic support, and new treatments, in particular new antiplatelet therapies, and also the increased experience with treating LMCA percutaneously and PCI in the context of STEMI, have slightly improved results and prognosis. However, STEMI caused by LMCA disease still has a poor prognosis, with the exception of the study by Liu et al, in which a surprisingly low in-hospital mortality rate (5.1%) and 30-day mortality (6.2%) were found [ 8 ]. Most of the studies reported an in-hospital mortality rate of 31–58% and a 30-day mortality of 36–63% [ 3 , 6 , 7 , 10 , 11 , 16 – 18 , 22 – 25 ].…”

Different associations between left atrial size and 2.5-year clinical outcomes in patients with anterior versus non-anterior wall ST-elevation myocardial infarction

“…ST-elevation myocardial infarction (STEMI) is a leading life-threatening disease worldwide. 1 Although primary percutaneous coronary intervention has been approved as the gold standard therapy for patients with STEMI over the past 20 years, [2][3][4] patients with anterior wall STEMI have a worse prognosis than those with non-anterior wall STEMI. 5 Therefore, developing prognostic markers for patients with STEMI is essential to enable clinicians to develop risk stratifications for these patients.…”

Major Adverse Cardiovascular Events: An Inevitable Outcome of ST-elevation myocardial infarction? A Literature Review

“…-One study identified as a cross-sectional study (n=1244) -one as case-control study and -one as a review article [28][29][30].…”