Emergency Percutaneous Coronary Intervention in Unprotected Left Main Coronary Arteries. Predictors of Mortality and Impact of Cardiogenic Shock

Long-term prognosis of patients with acute myocardial infarction due to unprotected left main coronary artery disease: a single-centre experience over 14 years

“…In a study by Hurtado et al, multivariate analysis showed that CS and incomplete revascularisation correlated with in-hospital mortality. (15) In another study by Parma et al, multivariate analysis showed that CS, age ≥ 75 years and postoperative blood flow of TIMI Grade 3 correlated with the 30-day mortality rate. (5) Similarly, our analysis suggests that CS (OR 5.86), well-developed collateral circulation (OR 0.14) and final flow of TIMI Grade 3 (OR 0.05) correlated with death during hospitalisation.…”

“…(15) However, in studies by Lee et al and Parma et al, all enrolled patients had STEMI. (3,5) As Iwasaki et al indicated, variations in ECG manifestation are related to differences in coronary artery dominance and collateral circulation.…”

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

“…By contrast, mortality in hemodynamically stable LM PCI patients was nearly twice as high as in hemodynamically stable non-LM PCI patients, reflecting the prognostic impact of LM disease. With respect to the role of cardiogenic shock in this clinical setting, Hurtado et al (15) reported a 66% prevalence of cardiogenic shock and a 61% in-hospital mortality in 71 consecutive patients treated with emergency PCI for LM disease. These data are in line with our results, highlighting the poor prognosis associated with cardiogenic shock (20) and the key role of an appropriate pharmacological and mechanical hemodynamic support, when needed.…”

“…Primary PCI has become the standard treatment for patients presenting with acute ST-segment elevation myocardial infarction (STEMI), including those with LM occlusion. Unlike patients with stable angina (8,9,11), however, limited data are available on patients with unprotected LM disease presenting with acute coronary syndromes (ACS) including STEMI (12)(13)(14)(15)(16). Therefore, we analyzed the clinical characteristics and outcomes of patients with STEMI treated with primary PCI for unprotected LM disease who were included in the nationwide acute myocardial infarction in Switzerland AMIS (Acute Myocardial Infarction in Switzerland) Plus registry between January 1, 2005, and June 30, 2010.…”

Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft in Aged Patients With Unprotected Left Main Artery Lesions

“…Different studies demonstrated a relatively high in-hospital mortality despite successful primary PCI in the subset of the population, which ranged from 16-38%. [24][25][26][27] The LM as infarct artery without collateral branches or a coronary bypass graft usually causes a large area of ischemia and deteriorates the left ventricular function. Afterwards, cardiac function is susceptible to a second strike as soon as the coronary flow recovers, namely reperfusion injury.…”