Unprotected Left Main Coronary Disease and ST-Segment Elevation Myocardial Infarction

Lee, Michael S.; Bokhoor, Pooya; Park, Seung‐Jung; Kim, Young‐Hak; Stone, Gregg W.; Sheiban, Imad; Biondi‐Zoccai, Giuseppe; Sillano, Dario; Tobis, Jonathan M.; Kandzari, David E.

doi:10.1016/j.jcin.2010.06.005

Cited by 65 publications

(27 citation statements)

References 29 publications

(13 reference statements)

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“…When comparing PCI with CABG in the acute setting of AMI, it must be remembered that clinical outcome is improved with any revascularization versus medical therapy alone. Furthermore, among revascularization patients, a treatment bias favoring performance of PCI rather than CABG in higher clinical-risk patients prohibits direct comparison between the 2 revascularization modalities and despite differences in patient groups and decisions for treatment, ULMCA PCI in STEMI is associated with similar survival rates compared with CABG (25).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery Disease as Culprit Lesion in Patients With Acute Myocardial Infarction

Pappalardo

Mamas

Imola

et al. 2011

JACC: Cardiovascular Interventions

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Patients with acute myocardial infarction and thrombosis of the unprotected left main coronary artery are a high-risk subgroup with a substantial mortality, particularly if they present in cardiogenic shock. We demonstrate that in these patients, PCI is a feasible treatment option associated with reasonably good outcomes. Long-term prognosis is excellent in hospital survivors with an 89.5% survival rate at 1 year.

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Section: Discussionmentioning

confidence: 99%

Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery Disease as Culprit Lesion in Patients With Acute Myocardial Infarction

Pappalardo

Mamas

Imola

et al. 2011

JACC: Cardiovascular Interventions

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“…Performed with the STEMI and NSTEMI groups separately, the candidate variables entered into regression equation were described by previous reports about the procedure for patients with ULMCA lesions. [ 1 2 3 4 5 6 9 10 11 12 14 ] The variables were removed if they produced P > 0.10. The results were presented as the hazard ratio ( HR ) and relative risk with the 95% confidence interval ( CI ).…”

Section: Ethodsmentioning

confidence: 99%

“…Patients who present with acute myocardial infarction (AMI), including those with ST-segment elevation MI (STEMI) and those with non-ST-segment elevation MI (NSTEMI) caused by acute unprotected left main coronary artery (ULMCA) occlusion, represent a very high-risk group of patients who may be susceptible to associated cardiogenic shock, malignant ventricular arrhythmias, and sudden death. [ 1 2 3 4 5 6 ] In patients presenting with AMI, primary percutaneous coronary intervention (PCI) is considered the optimal revascularization strategy. However, the current guidelines consider that the standard revascularization strategy for ULMCA disease is still coronary artery bypass graft.…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Han

Jing

et al. 2018

Chinese Medical Journal

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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.

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“…Clinical presentation in our patient population is an important indicator for acute and long-term prognosis. Compared with less severe conditions like UA or NSTEMI, patients presenting with STEMI with LMCA culprit lesion are critically ill, often leading to abrupt circulatory failure, fatal ventricular arrhythmia, and sudden cardiac death [28]. Since STEMI with culprit LMCA often leads to sudden death before the patient reaches hospital, we see a significantly lower proportion of hospitalized STEMI patients in the LMCA group (15.5% vs. 22.6%, p � 0.035), which is in accordance with a previous report [13].…”

Section: Discussionmentioning

confidence: 99%

Two-Year Outcomes after Left Main Coronary Artery Percutaneous Coronary Intervention in Patients Presenting with Acute Coronary Syndrome

Jia

Yao

Song

et al. 2020

Journal of Interventional Cardiology

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Objectives. We aim to evaluate long-term outcomes after left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome (ACS). Background. PCI of the LMCA has been an acceptable revascularization strategy in stable coronary artery disease. However, limited studies on long-term clinical outcomes of LMCA PCI in ACS patients are available. Methods. A total of 6429 consecutive patients with ACS undergoing PCI in Fuwai Hospital in 2013 were enrolled. Patients are divided into LMCA group and Non-LMCA group according to whether the target lesion was located in LMCA. Prognosis impact on 2-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed. Results. 155 (2.4%) patients had target lesion in LMCA, while 6274 (97.6%) patients belong to the non-LMCA group. Compared with non-LMCA patients, LMCA patients have generally more comorbidities and worse baseline conditions. Two-year follow-up reveals that LMCA patients have significantly higher rate of cardiac death (2.6% vs. 0.7%, p=0.034), myocardial infarction (7.1% vs. 1.8%, p<0.001), in-stent thrombosis (4.5% vs. 0.8%, p<0.001), and stroke (7.1% vs. 6.4%, p=0.025). After adjusting for confounding factors, LMCA remains independently associated with higher 2-year myocardial infarction rate (HR = 2.585, 95% CI = 1.243–5.347, p=0.011). Conclusion. LMCA-targeted PCI is an independent risk factor for 2-year myocardial infarction in ACS patients.

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Unprotected Left Main Coronary Disease and ST-Segment Elevation Myocardial Infarction

Cited by 65 publications

References 29 publications

Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery Disease as Culprit Lesion in Patients With Acute Myocardial Infarction

Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery Disease as Culprit Lesion in Patients With Acute Myocardial Infarction

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

Two-Year Outcomes after Left Main Coronary Artery Percutaneous Coronary Intervention in Patients Presenting with Acute Coronary Syndrome

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