Clinical features and outcome of emergency percutaneous intervention of left main coronary artery occlusion in acute myocardial infarction.
BACKGROUND
Acute myocardial infarction (AMI) due to left main coronary artery (LMCA) occlusion carries a grave prognosis. Large series reporting on the outcome of emergency revascularisation (percutaneous or surgical) of acute LMCA occlusion have been scarce. We seek to identify, in our local population, the clinical presentation and outcome of this group of patients.


METHODS
From January 2000 to December 2005, a total of 1,539 patients underwent primary percutaneous coronary angioplasty for AMI in our institution. 11 patients (0.8 percent) underwent percutaneous intervention to the LMCA. These patients became the subjects of our study. Data on demography, clinical features and outcome was collected from all in-hospital and clinical notes. One sub-investigator, who was blinded to the study outcome, assessed the angiographical features.


RESULTS
The overall inpatient mortality was 82 percent (9 out of 11). Nine out of 11 patients presented with cardiogenic shock. All patients presented with shock died during the hospital stay. All patients required intra-aortic balloon counter pulsation insertion. Of the two patients who survived till discharge, one had angioplasty followed by bypass surgery. The remaining one had angioplasty and stenting to the left main artery. Both survivors have been doing well without further major adverse cardiac event after an average of 64 months of follow-up.


CONCLUSIONS
Percutaneous revascularisation of acute LMCA occlusion is feasible and the best outcome is seen in stable patients. Prognosis is still poor in patients with unfavourable clinical features.
Department of Cardiology, National Heart Centre, Mistri Wing, 17 Third Hospital Avenue, Singapore 168752. tang_hak_chiaw@nhc.com.sg
H C
HC
Tang
A
A
Wong
P
P
Wong
T S J
TS
Chua
T H
TH
Koh
S T
ST
Lim
D000208:Acute Disease; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012846:Singapore; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome