Effect of Primary Angioplasty on Total or Subtotal Left Main Occlusion

Yip, Hon‐Kan; Wu, Chiung‐Jen; Chen, Mien‐Cheng; Chang, Hsueh‐Wen; Hsieh, Kelvin; Hang, Chi‐Ling; Fu, Morgan

doi:10.1378/chest.120.4.1212

Cited by 54 publications

(26 citation statements)

References 18 publications

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“…Previous studies have reported that the incidence of ST-elevation myocardial infarction (STEMI) caused by LMCA ranged from 0.8 to 2.5% in patients undergoing cardiac catheterization [ 3 , 6 , 11 , 15 – 17 ].…”

Section: Discussionmentioning

confidence: 99%

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

Gutiérrez-Barrios

Gheorghe

Camacho-Freire

et al. 2020

Journal of Interventional Cardiology

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Objectives. To determine the outcome predictors of in-hospital mortality in acute total occlusion of the left main coronary artery (ATOLMA) patients referred to emergent angioplasty and to describe the clinical presentation and the long-term outcome of these patients. Background. ATOLMA is an uncommon angiographic finding that usually leads to a catastrophic presentation. Limited and inconsistent data have been previously reported regarding true ATOLMA, yet comprehensive knowledge remains scarce. Methods. This is a multicenter retrospective cohort that includes patients presenting with myocardial infarction due to a confirmed ATOLMA who underwent emergency percutaneous coronary intervention (PCI). Results. In the period of the study, 7930 emergent PCI were performed in the five participating centers, and 46 of them had a true ATOLMA (0.58%). At admission, cardiogenic shock was present in 89% of patients, and cardiopulmonary resuscitation was required in 67.4%. All the patients had right dominance. Angiographic success was achieved in 80.4% of the procedures, 13 patients (28.2%) died during the catheterization, and the in-hospital mortality rate was 58.6% (27/46). At one-year and at the final follow-up, 18 patients (39%) were alive, including four cases successfully transplanted. Multivariate analysis showed that postprocedural TIMI flow was the only independent predictor of in-hospital mortality (OR 0.23, (95% CI 0.1–0.36), p<0.001). Conclusions. Our study confirms that the clinical presentation of ATOLMA is catastrophic, presenting a high in-hospital mortality rate; nevertheless, primary angioplasty in this setting is feasible. Postprocedural TIMI flow resulted as the only independent predictor of in-hospital mortality. In-hospital survivors presented an encouraging outcome. ATOLMA and left dominance could be incompatible with life.

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Section: Discussionmentioning

confidence: 99%

“…Only limited and inconsistent data have been reported regarding to percutaneous treatment of true ATOLMA. Previously reported studies have been largely confined to small cohorts and also included subtotal occlusion or critical stenosis of the LMCA [ 6 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

Gutiérrez-Barrios

Gheorghe

Camacho-Freire

et al. 2020

Journal of Interventional Cardiology

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“…Previous studies [13,14,15] have consistently reported that the prognosis of MI from acute LM occlusion is usually extremely poor without reperfusion therapy. Even in patients undergoing reperfusion therapy, prognosis remains less favorable than in those with other settings of AMI [13,14,15,16,17,18,19]. This could be the main reason for the reported unfavorable prognostic outcome of anterior-wall MI compared with inferior-wall MI with or without cardiogenic shock.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 30-Day Mortality between Anterior-Wall versus Inferior-Wall ST-Segment Elevation Myocardial Infarction Complicated by Cardiogenic Shock in Patients Undergoing Primary Coronary Angioplasty

Tsai¹,

Chai²,

Sun

et al. 2010

Cardiology

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Objectives: In this study, 30-day mortality from cardiogenic shock caused by left anterior descending artery (LAD) occlusion was compared with that caused by left circumflex (LCX) or right coronary artery (RCA) occlusion after primary percutaneous coronary intervention (PCI). Methods: Between May 2001 and December 2009, 212 consecutive patients with anterior-wall ST-elevation myocardial infarction complicated by cardiogenic shock due to LAD (n = 97) occlusion (group 1) and LCX or RCA (n = 115) occlusion (group 2) undergoing primary PCI were enrolled. Results: The results showed a higher mean peak level of creatine phosphokinase and incidence of extracorporeal membrane oxygenation in group 1 than group 2 (all p < 0.01). However, no significant difference was noted in the achievement of normal blood flow in the infarct-related artery (p = 0.461) and 30-day morality (p = 0.338). Univariate analysis demonstrated a significant association of 30-day morality with age, lower left-ventricular ejection fraction, advanced congestive heart failure and unsuccessful reperfusion (all p < 0.02). Multivariate analysis revealed unsuccessful reperfusion as the most independent predictor of 30-day mortality (p = 0.002). Conclusion: No significant difference was noted in 30-day mortality between patients with acute myocardial infarction and cardiogenic shock caused by LAD occlusion and by either RCA or LCX occlusion undergoing primary PCI.

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“…Yip et al [ 7 ] reported the results of PCI for total occlusion of the LMT in 8 patients and subtotal occlusion of the LMT in 10 patients. The procedural success rate in these cases was 72.2%.…”

Section: Discussionmentioning

confidence: 99%

A case of chronic left main trunk occlusion treated with off-pump coronary artery bypass grafting

Kawatani¹,

Nakamura²,

Hori³

2018

Journal of Surgical Case Reports

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Ischemic heart disease presents with various symptoms, and chest pain is a chief complaint. Occlusion of the left main trunk often results in serious symptoms such as cardiogenic shock. However, while extremely rare, left main trunk occlusion can present with only slight chronic symptoms. In the present case, a 62-year-old woman with few risk factors for ischemic heart disease visited our hospital complaining of exertional chest pain, which had gradually intensified over the past several years. Coronary artery computed tomography revealed total occlusion of the left main trunk, which was examined closely using coronary angiography. Coronary angiography showed that the left coronary artery was perfused by collateral pathways from the right coronary artery. The patient was thus diagnosed with chronic occlusion of the left main trunk. She underwent off-pump coronary artery bypass grafting, which proved to be an effective treatment.

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Effect of Primary Angioplasty on Total or Subtotal Left Main Occlusion

Cited by 54 publications

References 18 publications

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

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

Comparison of 30-Day Mortality between Anterior-Wall versus Inferior-Wall ST-Segment Elevation Myocardial Infarction Complicated by Cardiogenic Shock in Patients Undergoing Primary Coronary Angioplasty

A case of chronic left main trunk occlusion treated with off-pump coronary artery bypass grafting

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