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

Januszek, Rafał; Bujak, Kamil; Gąsior, Mariusz; Legutko, Jacek; Bartuś, Stanisław

doi:10.1097/md.0000000000024360

Cited by 1 publication

(6 citation statements)

References 21 publications

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“…This rapid deterioration can be attributed to the association of AMI resulting from LMCA occlusion/subtotal occlusion with cardiogenic shock and cardiac arrest shortly after the index event, which explains the dismal short-term prognosis. These findings are consistent with existing literature, which also reports a 50% mortality rate for cardiogenic shock complicating AMI [1][2][3][4]16,18 and a 40-60% in-hospital or 30 day mortality rate for unprotected LMCA occlusion over the past two decades. 4,9,17 However, it is essential to acknowledge that the actual mortality in this population is likely even higher, as many patients may have passed away before receiving medical care.…”

Section: Discussionsupporting

confidence: 92%

“…AMI due to unprotected LMCA occlusion/subtotal occlusion is characterized by frequent presentation with cardiogenic shock and is associated with significant mortality and morbidity 1–5,16–18 . In our study population, the majority of patients exhibited cardiogenic shock, and more than a quarter experienced cardiac arrest.…”

Section: Discussionmentioning

confidence: 79%

“…14,15 AMI due to unprotected LMCA occlusion/subtotal occlusion is characterized by frequent presentation with cardiogenic shock and is associated with significant mortality and morbidity. [1][2][3][4][5][16][17][18] In our study population, the majority of patients exhibited cardiogenic shock, and more than a quarter experienced cardiac arrest. Additionally, there was a trend towards a higher proportion of patients admitted with car-diac arrest or cardiogenic shock, in contrast to a lower proportion of patients admitted with chest pain (Figure 2).…”

Section: Discussionmentioning

confidence: 99%

“…7,26 PCI of unprotected LMCA culprit lesions are often complex procedures requiring a combination of skill and speed, particularly in the acute setting when patients are often haemodynamically unstable. 5,18 This creates an extremely high-risk group of patients whose prognosis is poor by design. 18 Although PCI was performed in a very challenging context, our study demonstrated that successful revascularization can be predictably achieved with angiographic success rates of approximately 70%, even in this high-risk subgroup.…”

Section: Discussionmentioning

confidence: 99%

“…PCI of unprotected LMCA culprit lesions are often complex procedures requiring a combination of skill and speed, particularly in the acute setting when patients are often haemodynamically unstable 5,18 . This creates an extremely high‐risk group of patients whose prognosis is poor by design 18 .…”

Section: Discussionmentioning

confidence: 99%

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Twelve‐year trends in unprotected left main coronary artery occlusion: insights from a real‐world multicentre study

Alexandre,

Campinas,

Brochado

et al. 2024

ESC Heart Failure

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AimsAcute myocardial infarction (AMI) resulting from unprotected left main coronary artery (LMCA) occlusion and subtotal occlusion is a life‐threatening condition. Although AMI management has improved in the past two decades, there is limited information on recent trends in patient characteristics, management, and outcomes for acute unprotected LMCA‐related AMI. This study aims to assess such trends over a 12 year period.Methods and resultsThis retrospective multicentre study includes patients with unprotected LMCA occlusion/subtotal occlusion admitted to three tertiary hospitals between 2008 and 2020. The patients were divided into two groups based on the chronology of presentation: a ‘past group’ (January 2008 to December 2014) and a ‘contemporary group’ (January 2015 to December 2020). The study compares clinical characteristics, management approaches, and outcomes between the two groups. The study includes 128 patients, with 51 (40%) in the ‘past group’ and 77 (60%) in the ‘contemporary group’. Baseline risk factors did not show statistically significant differences between the two groups, except for hypertension (49% vs. 74%; P = 0.005). Chest pain was more frequent in the ‘past group’ (98% vs. 89%; P = 0.014), and a trend towards more cardiac arrests was observed in the ‘contemporary group’ (18% vs. 31%; P = 0.087). Revascularization type did not differ significantly (P = 0.419), but manual thrombectomy was less frequently used (41% vs. 23%; P = 0.032) and stent implantation showed a trend towards higher rates (66% vs. 78%; P = 0.150) in the ‘contemporary cohort’. There was a gradual shift from bare‐metal to drug‐eluting stents, with a significantly higher percentage of ticagrelor/prasugrel loading in the ‘contemporary cohort’ (5% vs. 79%; P < 0.001). The use of mechanical circulatory support (MCS), although not statistically significant, was higher among patients in the ‘past group’ (67% vs. 51%; P = 0.073). The type of MCS differed significantly between groups, with a decrease in intra‐aortic balloon pump use (67% vs. 42%; P = 0.005) and an increase in veno‐arterial extracorporeal membrane oxygenation (4% vs. 22%; P = 0.005) and Impella system (0% vs. 3%) over time. Survival analysis showed no significant differences (P = 0.599; log‐rank test) in all‐cause mortality between the different time groups, with the long‐term survival rate being approximately 30%.ConclusionsIn our real‐world population, despite the progressive use of newer drugs and more advanced devices over time, patients with unprotected LMCA occlusion/subtotal occlusion remain a subpopulation with poor prognosis.

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