Left main intervention revisited: Early and late outcome of PTCA and stenting

Chauhan, Anoop; Zubaid, Mohammad; Ricci, Donald R.; Buller, Christopher E.; Moscovich, Michael D.; Mercier, Brenda; Fox, Rebecca; Penn, I

doi:10.1002/(sici)1097-0304(199705)41:1<21::aid-ccd7>3.0.co;2-c

Cited by 44 publications

(33 citation statements)

References 25 publications

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“…However, no specific predictors of LMCA thrombosis have been identified so far. Electrocardiography has variably demonstrated ST segment elevation in most patients or diffuse ST segment depression in the anterior precordial leads, and cardiac enzymes are typically elevated in most cases [1][2][3][4][5].…”

Section: Clinical Presentation Of Lmca Thrombosissupporting

confidence: 86%

“…Most reported cases of LMCA thrombosis have presented with acute pulmonary edema requiring ventilatory support, AMI (ST/ non-ST segment elevation), cardiac arrest, cardiogenic shock or sudden cardiac death [1][2][3][4][5]27]. In one study, 63% of the 24 patients with LMCA occlusion presented with cardiogenic shock, 42% were intubated and all required IABP [1].…”

Section: Clinical Presentation Of Lmca Thrombosismentioning

confidence: 99%

“…Left main coronary artery (LMCA) disease with acute myocardial infarction (AMI) has a reported mortality of 40-80% and represents a particularly high-risk subset of patients with AMI [1][2][3][4][5]. Although it might be more common than reported, most of our current knowledge regarding this entity comes from case-reports or small retrospective studies.…”

Section: Introductionmentioning

confidence: 99%

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Left Main Coronary Artery Thrombus: A Case Series with Different Outcomes

Gupta

Rahman

Uretsky

et al. 2005

J Thromb Thrombolysis

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Left main coronary artery (LMCA) thrombosis with acute myocardial infarction is an uncommon condition with an extremely high mortality. The small number of reported cases prevents the development of an evidence-based approach. Hence there are no clear-cut guidelines describing the best management approach for this condition. We describe our experience with six patients who presented with LMCA thrombosis and discuss the epidemiology, etiology and management options available for this high-risk subgroup.

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Section: Clinical Presentation Of Lmca Thrombosissupporting

confidence: 86%

Section: Clinical Presentation Of Lmca Thrombosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Left Main Coronary Artery Thrombus: A Case Series with Different Outcomes

Gupta

Rahman

Uretsky

et al. 2005

J Thromb Thrombolysis

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“…Definitions of several patient characteristics, such as "not a candidate for bypass surgery," are subjective and certainly varied between institutions. Finally, although generally supported by the experiences of Kosuga et al, 9 Park et al, 10 Silvestri et al, 30 Chanhan et al, 35 and others, the low-risk group identified in this study requires prospective confirmation.…”

Section: Tan Et Al Outcomes After Unprotected Lmt Pcimentioning

confidence: 99%

Long-Term Clinical Outcomes After Unprotected Left Main Trunk Percutaneous Revascularization in 279 Patients

et al. 2001

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for the ULTIMA Investigators* Background-Percutaneous coronary revascularization (PCI) has been increasingly applied to unprotected left main trunk (LMT) lesions, with varied long-term success. This study attempts to define the predictors of outcome in this population. Methods and Results-Two hundred seventy-nine consecutive patients who had LMT PCI at 1 of 25 sites between 1993 and 1998 were studied. Forty-six percent of these patients were deemed inoperable or at high surgical risk. Thirty-eight patients (13.7%) died in hospital, and the rest were followed up for a mean of 19 months. The 1-year incidence was 24.2% for all-cause mortality, 20.2% for cardiac mortality, 9.8% for myocardial infarction, and 9.4% for CABG. Independent correlates of all-cause mortality were left ventricular ejection fraction Յ30%, mitral regurgitation grade 3 or 4, presentation with myocardial infarction and shock, creatinine Ն2.0 mg/dL, and severe lesion calcification. For the 32% of patients Ͻ65 years old with left ventricular ejection fraction Ͼ30% and without shock, the prevalence of these adverse risk factors was low. No periprocedural deaths were observed in this low-risk subset, and the 1-year mortality was only 3.4%. Conclusions-Patients undergoing unprotected LMT PCI have frequent serious comorbidities and consequently have high event rates. PCI may be an alternative to CABG for a select proportion of elective patients and may also be appropriate for highly symptomatic inoperable patients. Meticulous follow-up of hospital survivors is required because of the rather high mortality during the first few months after treatment.

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“…This result is in agreement with a previous report. 22) An important observation from our study is the poor outcome of patients with left main coronary artery occlusion with cardiogenic shock despite the use of stents and PCPS support. Therefore, emergent coronary stenting in the LMCA may have allowed the patient to achieve and maintain a good hemodynamic status as a bridge to emergency surgical revascularization at the moment.…”

Section: -13)mentioning

confidence: 99%

Factors Predicting Mortality in Patients after Myocardial Infarction Caused by Left Main Coronary Artery Occlusion. Significance of ST Segment Elevation in Both aVR and aVL Leads.

et al. 2000

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SUMMARYAcute left main coronary artery obstruction is rare and most patients in this clinical setting die of sudden death or cardiogenic shock. During the past 8 years, we encountered 13 patients with acute myocardial infarction caused by total occlusion of the left main coronary artery (LMCA-AMI). Thus, we surveyed these patients, and attempted to elucidate helpful predictors related to the prognosis. Six of 13 patients with LMCA-AMI survived. Successful left coronary artery dilatation was achieved in all survivors (group S), and in 5 (71%) non-survivors (group non-S). The age was not different between the two groups. A past history of angina was confirmed in 83% of group S, while only in 29% of group non-S. Clinical findings such as time of onset of AMI, interval from the AMI onset to admission, elapsed period from the AMI onset to recanalization of LMCA and the value of CK on admission were not different between the two groups. However, cardiogenic shock occurred in only 1 patient (17%) in group S compared with 5 patients (71%) in group non-S. As emphasized in the literature, good collateral circulation to the left anterior descending artery was observed in 5 patients (83%) in group S, while not observed in group non-S. Electro cardiographically, ST elevation in the aVR lead was very characteristic. This finding was confirmed in 69% of the total patients. Noticeably, 5 out of 6 non-survivors (83%) showed ST elevation not only in leads aVR but also in the aVL lead. In addition to the absence of collateral circulation, this electrocardiographic finding, which obviously indicates the presence of extensive myocardial ischemia in the diseased heart, is a simple and important predictor suggesting a poor prognosis in LMCA-AMI patients. (Jpn Heart J 2000; 41: 571-581) Key words: Total occlusion of the left main coronary artery, Acute myocardial infarction, Prognosis, ST elevation in aVR and aVL leads DUE to the increasing development of cardiac emergency systems including the Coronary Care Unit (CCU) and also early revascularization therapy such as per-

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Left main intervention revisited: Early and late outcome of PTCA and stenting

Cited by 44 publications

References 25 publications

Left Main Coronary Artery Thrombus: A Case Series with Different Outcomes

Left Main Coronary Artery Thrombus: A Case Series with Different Outcomes

Long-Term Clinical Outcomes After Unprotected Left Main Trunk Percutaneous Revascularization in 279 Patients

Factors Predicting Mortality in Patients after Myocardial Infarction Caused by Left Main Coronary Artery Occlusion. Significance of ST Segment Elevation in Both aVR and aVL Leads.

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