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

Xu, Li; Sun, Hao; Wang, Lefeng; Yang, Xinchun; Li, Kui-Bao; Zhang, David; Wang, Hong-shi; Li, Weiming

doi:10.11622/smedj.2016121

Cited by 9 publications

(14 citation statements)

References 27 publications

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“…All-cause mortality at 30 days reached 35.8%, being comparable to previous studies [1–8, 10, 11, 13, 14]. The majority of deaths occurred in the first 30 days from the index event, and seven additional deaths were recorded between 30-day and one-year follow-up.…”

Section: Discussionsupporting

confidence: 87%

New Predictors of Early and Late Outcomes after Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Unprotected Left Main Coronary Artery Culprit Lesion

Homorodean

Iancu

Leucuţa

et al. 2019

Journal of Interventional Cardiology

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Objectives. The study evaluated the correlation between baseline SYNTAX Score, Residual SYNTAX Score, and SYNTAX Revascularization Index and long-term outcomes in ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) on an unprotected left main coronary artery lesion (UPLMCA). Background. Previous studies on primary PCI in UPLMCA have identified cardiogenic shock, TIMI 0/1 flow, and cardiac arrest, as prognostic factors of an unfavourable outcome, but the complexity of coronary artery disease and the extent of revascularization have not been thoroughly investigated in these high-risk patients. Methods. 30-day, 1-year, and long-term outcomes were analyzed in a cohort of retrospectively selected, 81 consecutive patients with STEMI, and primary PCI on UPLMCA. Results. Cardiogenic shock (p=0.001), age (p=0.008), baseline SYNTAX Score II (p=0.006), and SYNTAX Revascularization Index (p=0.046) were independent mortality predictors at one-year follow-up. Besides cardiogenic shock (HR 3.28, p<0.001), TIMI 0/1 flow (HR 2.17, p=0.021) and age (HR 1.03, p=0.006), baseline SYNTAX Score II (HR 1.06, p=0.006), residual SYNTAX Score (HR 1.03, p=0.041), and SYNTAX Revascularization Index (HR 0.9, p=0.011) were independent predictors of mortality at three years of follow-up. In patients with TIMI 0/1 flow, the presence of Rentrop collaterals was an independent predictor for long-term survival (HR 0.24; p=0.049). Conclusions. In this study, the complexity of coronary artery disease and the extent of revascularization represent independent mortality predictors at long-term follow-up.

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Section: Discussionsupporting

confidence: 87%

New Predictors of Early and Late Outcomes after Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Unprotected Left Main Coronary Artery Culprit Lesion

Homorodean

Iancu

Leucuţa

et al. 2019

Journal of Interventional Cardiology

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“…In this issue, Xu et al's report of their centre's experience will help in understanding the longer-term outcomes of survivors. (16) In this study, in a mean follow-up period of 44.6 months, the overall mortality was > 50%, with a cumulative survival rate of only 30.7%. Consistent with other case series, in-hospital cardiogenic shock was a predictor of mortality.…”

mentioning

confidence: 54%

Changes in the practice of cardiology: therapies at the forefront of science

Loh

Poh

2016

smedj

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T he practice of cardiology has evolved significantly over the years. The availability of current diagnostics and therapeutics has enabled physicians to treat increasingly complex cardiovascular diseases (CVDs). Despite this, the burden of CVD is increasing in Southeast Asia, with ischaemic heart disease and cerebrovascular disease accounting for the majority of cardiac-related deaths in this region.(1) To address these unmet needs, we must first acknowledge that Asian-specific data is required to better understand treatment effect on Asian populations, in particular the heterogeneous composition in Southeast Asia. This issue of the Singapore Medical Journal (SMJ) features a collection of local and Asian original research and review articles, which centres on current and novel approaches to treating CVD.Managing cardiovascular risk factors is the cornerstone of cardiology practice. In the practice of preventative cardiology, there is an ongoing controversy with regard to managing cholesterol levels to lower cardiovascular risk. In particular, the 2013 American College of Cardiology/American Heart Association Cholesterol Treatment Guidelines adopted a statin-centric approach, disregarding low-density lipoprotein (LDL) goals.(2) Similarly, the revised 2015 American Diabetes Association guidelines also recommended high-intensity statins for diabetic patients.(3) In contrast, the Europeans adopted an LDL-centric approach based on cardiovascular risks.(4) How do we adopt these seemingly differing recommendations in our daily practice? Are the risk prediction models developed based on Western populations accurate in Asian patients? Are Asians more intolerant of high-dose statins? The review article by Yan et al summarises the key findings and recommendations of these various guidelines.(5) The Singapore Ministry of Health (MOH) guidelines on lipids have not yet been published. These two articles (Yan et al and the yet to be published MOH guidelines) will discuss key principles for effective management of cardiovascular risk locally.Teong et al focused on the treatment effect of valsartan, an angiotensin receptor blocker (ARB), in a group of hypertensive Asians, as measured using central aortic systolic pressure (CASP).(6) This study used the BPro® (radial pulse wave acquisition device) watch to measure the CASP by capturing radial arterial waveforms at the wrist.(7) The BPro watch, developed by Dr Ting Choon Meng, a Singaporean doctor and an inventor of medical devices, was validated to accurately measure CASP.(8) This study is important to the cardiology community, as CASP has been shown to predict cardiovascular events better than brachial blood pressure.(9) Moreover, ARBs are thought to act more favourably on CASP than other classes of antihypertensive drugs, albeit only in Western populations. (10) This open-label prospective cohort study, which demonstrates the changes in CASP with treatment over 12 weeks in an Asian population, reflects the potential in marrying the use of locally developed medical technology an...

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“…The l mortality during the mean 44.6 months of follow-up period was 52.7%. [ 21 ] Among the predictors of in-hospital mortality, the authors found cardiogenic shock, lack of TIMI 3 grade flow after PCI and collateral circulation of grade 2 or 3. While among the predictors of the overall mortality, only cardiogenic shock remained.…”

Section: Discussionmentioning

confidence: 99%

“…While among the predictors of the overall mortality, only cardiogenic shock remained. [ 21 ] In a different study, the complexity and extent of dissemination of coronary artery stenosis were additionally confirmed as predictors of 1- and 3-year mortality in patients with STEMI and treated due to unprotected LMCA disease. [ 22 ] The in-hospital mortality rate was 30.8%, 1-year mortality was 44.4% and 3-year mortality was 54.3%.…”

Section: Discussionmentioning

confidence: 99%

Survival rate after acute myocardial infarction in patients treated with percutaneous coronary intervention within the left main coronary artery according to time of admission

Januszek¹,

Bujak

Gąsior

et al. 2021

Medicine

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The relationship regarding time of percutaneous coronary intervention (PCI) and clinical outcomes in patients with acute myocardial infarction (AMI) treated within the left main coronary artery (LMCA) is less investigated compared to the overall group of patients with AMI. Therefore, we aimed to assess the relationship between time of PCI (day- vs night-time) and overall mortality rate in patients treated due to AMI within the LMCA. This cross-sectional study included 443,805 AMI patients hospitalized between 2006 and 2018 enrolled in the Polish Registry of Acute Coronary Syndromes. We extracted 5,404 patients treated within the LMCA. The number of patients were treated during daytime hours (7:00 am–10:59 pm) was 2809 while 473 patients underwent treatment during night-time hours (11:00 pm–6:59 am). Differences in cardiac mortality rates between night- and day-hours among patients treated with PCI during the follow-up period were assessed via the Kaplan–Meier method. The 30-day (20.3% vs 14.9%, P = .003) and 12-month (31.7% vs 26.2%, P = .001) overall mortality rates were significantly greater among patients treated during night-time, which was confirmed by comparison using Kaplan–Maier survival curves ( P = .001). The time of PCI was not found among predictors of survival in multiple regression analysis (hazard ratio: 1.22; 95% confidence interval: 0.96-1.55, P = .099). Patients treated during night-time in comparison to the day-time are related to higher in-hospital, 30-day and 12-month mortality. This is probably largely a consequence that the night-time, in comparison to the day-time, of treatment of patients with AMI with PCI within the LMCA is and indicator of higher comorbidity and clinical acuity of patients undergoing therapy. Therefore, the night-time was not found to be an independent predictor of greater mortality rate during the 12-months follow-up period.

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

Cited by 9 publications

References 27 publications

New Predictors of Early and Late Outcomes after Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Unprotected Left Main Coronary Artery Culprit Lesion

New Predictors of Early and Late Outcomes after Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Unprotected Left Main Coronary Artery Culprit Lesion

Changes in the practice of cardiology: therapies at the forefront of science

Survival rate after acute myocardial infarction in patients treated with percutaneous coronary intervention within the left main coronary artery according to time of admission

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