Clinical outcomes and predictors of unprotected left main stem culprit lesions in patients with acute ST segment elevation myocardial infarction

Baek, Ju Yeol; Seo, Suk Min; Park, Hun‐Jun; Kim, Pum Joon; Park, Mahn Won; Koh, Yoon Seok; Chang, Kai-Hsiung; Jeong, Myung Ho; Park, Seung Jung; Seung, Ki‐Bae

doi:10.1002/ccd.23420

Cited by 17 publications

(12 citation statements)

References 21 publications

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“…Reviewing the literature, there is a worldwide variety in the management of PPCI of ULMCA concerning drug-eluting stent (DES) or bare metal stent (BMS) use. Most of the contemporary European, Australian and Japanese studies reported dominant BMS8 17 or mixed BMS/DES1 3 16 18 21 use, while in the Korean studies, most PPCIs of the ULMCA were performed with DES 9 14 19. Previous large meta-analyses comparing DES with BMS in patients with stable angina/acute coronary syndromes38 and STEMI39 consistently showed no benefit of DES concerning death or MI, whereas revascularisation rates were significantly lower with DES.…”

Section: Discussionmentioning

confidence: 99%

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

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Beijk

et al. 2013

Heart

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Section: Discussionmentioning

confidence: 99%

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

Grundeken

Vis

Beijk

et al. 2013

Heart

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“…Clinical presentation in ST-elevation myocardial infarction (STEMI) varies depending on the affected coronary artery. Several studies have compared outcome in anterior versus non-anterior infarctions, stratifying patients based on electrocardiography (ECG) patterns, rather than angiographic findings 3–5. A comparison of anterior infarctions with inferior, using ECG-based stratification, concluded that anterior infarction resulted in larger infarct size, lower left ventricular ejection fraction (LVEF) on admission, more heart failure, more in-hospital deaths and more cardiac mortality (even after adjusting for infarct size).…”

Section: Introductionmentioning

confidence: 99%

Culprit vessel: impact on short-term and long-term prognosis in patients with ST-elevation myocardial infarction

et al. 2018

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BackgroundST-elevation myocardial infarction (STEMI) occurs as a result of rupture of an atherosclerotic plaque in the coronary arteries. Limited data exist regarding the impact of culprit coronary vessel on hard clinical event rates. This study investigated the impact of culprit vessel on outcomes after primary percutaneous coronary intervention (PCI) of STEMI.MethodsA total of 29 832 previously cardiac healthy patients who underwent primary PCI between 2003 and 2014 were prospectively included from the Swedish Coronary Angiography and Angioplasty Registry and the Registry of Information and Knowledge about Swedish Heart Intensive care Admissions. Patients were stratified into three groups based on culprit vessel (right coronary artery (RCA), left anterior descending artery (LAD) and left circumflex artery (LCx)). The primary outcome was 1-year mortality. The secondary outcomes included 30-day and 5-year mortality, as well as heart failure, stroke, bleeding and myocardial reinfarction at 30 days, 1 year and 5 years. Univariable and multivariable analyses were done using Cox regression models.ResultsOne-year analyses revealed that LAD infarctions had the highest increased risk of death, heart failure and stroke compared with RCA infarctions, which had the lowest risk. Sensitivity analyses revealed that reduced left ventricular ejection fraction on discharge partially explained this increased relative risk in mortality. Furthermore, landmark analyses revealed that culprit vessel had no significant influence on 1-year mortality if a patient survived 30 days after myocardial infarction. Subgroup analyses revealed female sex and multivessel disease (MVD) as significant high-risk groups with respect to 1-year mortality.ConclusionsLAD and LCx infarctions had a relatively higher adjusted mortality rate compared with RCA infarctions, with LAD infarctions in particular being associated with an increased risk of heart failure, stroke and death. Culprit vessel had limited influence on mortality after 1 month. High-risk patient groups include LAD infarctions in women or with concomitant MVD.

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“…A súlyo-san csökkent ejectiós frakció (EF<35%) ugyancsak az LM-és a LAD-betegcsoportokban volt szignifikánsan gyakoribb az RCA-és LCx-csoportokhoz hasonlítva. Baek és mtsai [13] a Koreai Infarktus Regiszter anyagá-ban összehasonlították az LM és az egyéb éren végzett PCI eredményességét és azt találták, hogy az LM-betegcsoportban az utánkövetés 12 hónapja alatt magasabb volt a súlyos kardiális események előfordulása (cardiovascularis halálozás, nem halálos reinfarktus és az ismételt revascularisatio). A különbség döntően az 1 hónap alatt bekövetkező halálesetekből adódott.…”

Section: Megbeszélésunclassified

A szívinfarktusért felelős ér prognosztikus jelentőségének vizsgálata ST-elevációs szívinfarktusos betegekben

et al. 2016

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Bevezetés: A szívinfarktust okozó ér prognosztikai jelentőségére vonatkozóan kevés irodalmi adat áll rendelkezésre, különösen azokban az esetekben, amikor a betegeknél katéteres revascularisatio történt. Célkitűzés: A szerzők célul tűzték ki annak vizsgálatát, hogy a szívinfarktusért felelős érnek (culprit vessel) van-e prognosztikus jelentősége STelevációs myocardialis infarctusos betegekben, akiknél sikeres katéteres érmegnyitás (percutan coronariaintervenció) történt. Módszer: Retrospektív vizsgálatukban 10 763 beteg adatait elemezték. A szívinfarktusért felelős ér alapján négy betegcsoportot alakítottak ki: főtörzs, bal leszálló ág, bal körbefutó ág és jobb koszorúér. Az adatok értékelése-kor egyváltozós túlélési görbéket konstruáltak, illetve elvégezték a túlélési idő többváltozós modellezését Cox-regresszióval, az életkor, a nem és a társbetegségek figyelembevételével. Eredmények: Leggyakrabban a bal leszálló ág (44,3%), ezt követte a jobb koszorúér (40,9%), majd a bal körbefutó ág (13,7%), míg a főtörzs 1%-ban volt felelős az infarktus kialakulásáért. Az egyéves túlélés szempontjából a szívinfarktusért felelős ér szignifikáns prognosztikai jelentőséggel bírt (p<0,0001): a jobb koszorúér esetén a hazard ratio 0,69 (95%-os CI: 0,61-0,79, p<0,0001), a főtörzs esetén 1,56 (95%-os CI: 1,04-2,35, p = 0,0321) volt a referenciaérhez (bal leszálló ág) viszonyítva. Következtetés: A vizsgálat eredményei igazolják a szívinfarktusért felelős ér prognosztikai jelentőségét. Orv. Hetil., 2016, 157(32), 1282-1288.Kulcsszavak: ST-elevációs myocardialis infarctus, percutan coronariaintervenció, infarktusért felelős ér, prognózis Prognostic significance of the culprit vessel in patients with ST-elevation myocardial infarction treated with primary coronary interventionIntroduction: To the best of the authors' knowledge, very few publications are available which report on the prognostic significance of the culprit vessel in patients with ST elevation myocardial infarction treated with successful primary percutaneous coronary intervention. Aim: The aim of the authors was to obtain data on the significance of the culprit vessel in patients with ST elevation myocardial infarction treated successfully by primary percutaneous coronary intervention. Method: The authors performed a retrospective study in 10,763 patients with ST elevation myocardial infarction who underwent successful primary percutaneous coronary intervention. The culprit vessels were the left main artery, left anterior descendent artery, left circumflex artery, and right coronary artery. The authors constructed univariate survival curves for different culprit vessels and also performed multivariate modelling of timeto-death, controlling for age, sex, and comorbidities. Results: The majority of the culprit lesions were found in the left anterior descendent artery (44.3%), the right coronary artery (40.9%), and the left circumflex artery (13.7%). The culprit vessel was overall a highly significant (p<0.0001) factor of survival, with right coronary artery exhibiting a ...

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Clinical outcomes and predictors of unprotected left main stem culprit lesions in patients with acute ST segment elevation myocardial infarction

Cited by 17 publications

References 21 publications

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

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

Culprit vessel: impact on short-term and long-term prognosis in patients with ST-elevation myocardial infarction

A szívinfarktusért felelős ér prognosztikus jelentőségének vizsgálata ST-elevációs szívinfarktusos betegekben

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