Left main percutaneous coronary intervention in ST elevation myocardial infarction.
BACKGROUND
ST-elevation myocardial infarction (STEMI) with the culprit lesion in the left main artery is a rare cardiac emergency with a poor prognosis.


OBJECTIVE
Review and prognosis evaluation of primary percutaneous coronary intervention (PCI) performed in the setting of STEMI with left main occlusion in a single high-volume center.


METHODS
Of the 483 primary or rescue PCIs performed and followed in our hospital during a 24-month period (August 2004 to July 2006), we retrospectively evaluated those involving left main procedures and analyzed in-hospital mortality and major cardiac events (MACE) in a 12-month follow-up. We found nine patients, age 68 +/- 9 years, five male, seven with multivessel disease and two with isolated left main disease. Rescue PCI was performed in three patients and primary PCI in the others.


RESULTS
Seven patients presented in cardiogenic shock and two were classified in Killip class II on admission. Inotropic drugs, intra-aortic balloon pump and abciximab were used in eight patients. Drug-eluting stents were used in six patients, bare-metal stents in two, and isolated balloon angioplasty in one. Five patients (55%) died in the hospital and the four discharged home (two of them aged 81 and 82 years) were still alive and free from MACE at 12-month follow-up.


CONCLUSIONS
Clinical presentation of STEMI with the culprit lesion in the left main artery was very severe. During PCI, drug-eluting stents, intra-aortic balloon pump and abciximab were used in almost all patients. This entity had a high mortality rate even though primary PCI was performed. Those who survived had a good mid-term prognosis.
Ramos
Ruben
R
Serviço de Cardiologia, Hospital de Santa Marta, Lisboa, Portugal. nebursomar79@yahoo.com
Patrício
Lino
L
Abreu
Ana
A
Soares
Cristina
C
Mamede
Andreia
A
Fernandes
Rita
R
Gâmboa
Paula
P
Timóteo
Ana
A
Sousa
Lídia
L
Cacela
Duarte
D
Bernardes
Luís
L
Ferreira
Rui Cruz
RC
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies