Primary Percutaneous Coronary Intervention for Unprotected Left Main Disease in Patients With Acute ST-Segment Elevation Myocardial Infarction

Abstract

Emergent LM PCI in the context of acute myocardial infarction, even including 12% cardiogenic shock, appears to have a remarkably high (89%) in-hospital survival. Concurrent LM and non-LM PCI has worse outcomes than isolated LM PCI.

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)

“…The majority of the initial data have been provided by small cohorts/series from more than a decade prior . In recent times, several more contemporary registries have also reported their data with differing results …”

Longitudinal Distribution of Plaque Burden and Necrotic Core–Rich Plaques in Nonculprit Lesions of Patients Presenting With Acute Coronary Syndromes

“…with: 1) the CASS (Coronary Artery Surgery Study), which found asymptomatic LMCA lesions in a minority (1,477 of 20,137) of patients (19); 2) the observation of Wang et al (12) who reported only 1 LMCA acute occlusion out of 208 patients presenting with an acute STEMI; and 3) recent studies of Pappalardo et al (20), who reported that only 48 of 5,261 STEMI/non-STEMI patients presented with an LMCA culprit lesion, and Pedrazzini et al (21), who reported that only 348 of 9,075 STEMI patients presented with an LMCA culprit lesion.…”

Left Main Percutaneous Coronary Intervention

“…Data regarding clinical outcomes in this patient cohort are limited to small observational studies that suffer from substantial confounding. Patients with acute MI and a left main culprit lesion are more frequently in cardiogenic shock and are more likely to have suffered cardiac arrest before intervention compared with patients with culprit lesions in other parts of the coronary tree (15,16). Among PCI registries, in-hospital mortality is high (21% to 58%) and is related to the prevalence of cardiogenic shock within the cohort studied, but patients surviving hospitalization seem to have an excellent long-term prognosis (16).…”