Primary angioplasty of unprotected left main coronary artery for acute anterolateral myocardial infarction.
BACKGROUND
Mortality of acute unprotected left main coronary artery (LMCA) occlusion is very high. The objectives of this analysis were to determine the effect of primary angioplasty and the impact of cardiogenic shock on unprotected LMCA occlusion-induced acute anterolateral myocardial infarction (AAMI).


METHODS
Of 1,736 consecutive patients with acute myocardial infarction (AMI), 38 (2.2%) had LMCA occlusion-induced AAMI with Thrombolysis in Myocardial Infarction (TIMI) flow less than or equal to 2. All were given primary angioplasty.


RESULTS
Of these 38 patients, 17 (45%) were discharged, and 21 (55%) died in-hospital. Cardiogenic shock was overt in 28 patients; 47.1% of the survival group and 95.2% of the mortality group (p=0.0008). On arrival, the survival-group had higher pH (7.40+/-0.10 vs. 7.30+/-0.14; p=0.013) and base excess (-4.5+/-3.9 vs. -10.4+/-6.0 mEq/L; p=0.0013). In the survival group reperfusion was successful in 100% of patients, as opposed to 57.1% in the mortality group (p=0.0020), and the incident of stenting was not different between the two groups (64.7% vs. 71.4%, p=0.66). Shock patients had lower successful angioplasty rate (67.9% vs. 100%, p=0.040), higher in-hospital mortality (71.4% vs. 10.0%, p=0.0008), and higher 1-year mortality rates (p=0.0064), than stable patients. All shock patients with failed angioplasty died, but the mortality rate was 57.9% (p=0.021) when angioplasty was successful.


CONCLUSIONS
Patients presenting with AAMI, LMCA occlusion, and cardiogenic shock have poor survival regardless of primary angioplasty in conjunction with coronary stents. Nevertheless, primary angioplasty is a feasible and effective procedure, and it may save lives in this clinical setting.
Sakai
Koyu
K
Masakiyo Nobuyoshi, MD, Kokura Memorial Hospital, 1-1 Kifune-machi, Kokurakita-ku, Japan, 802-8555. kmhptca@nn.iij4u.or.jp.
Nakagawa
Yoshihisa
Y
Kimura
Takeshi
T
Ando
Kenji
K
Yokoi
Hiroyoshi
H
Iwabuchi
Masashi
M
Inoue
Katsumi
K
Nosaka
Hideyuki
H
Nobuyoshi
Masakiyo
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality*; D016022:Case-Control Studies; D002423:Cause of Death; D017023:Coronary Angiography / Q000379:methods; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000150:complications* / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome