title: Primary percutaneous coronary intervention for acute myocardial infarction caused by unprotected left main stem thrombosis.
abstract: BACKGROUND
  There is a paucity of data on outcomes in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) caused by left main stem (LMS) thrombosis.
  
  
  OBJECTIVE
  We sought to determine (i) the clinical features, (ii) correlates of early mortality, and (iii) long-term outcomes in contemporary patients undergoing primary PCI for unprotected LMS thrombosis.
  
  
  METHODS
  From 1,115 consecutive primary PCI cases at two tertiary referral centers between January 2004 and September 2007, 28 cases (2.5%) with unprotected LMS culprit lesions were identified. Data were obtained from review of institutional databases, folder audit, telephone survey of patients, and independent review of angiograms.
  
  
  RESULTS
  The mean age of patients was 68 +/- 14 years. Males comprised 76%, and 21% had diabetes. Significant morbidity was noted at presentation: shock in 18 (62%), pulmonary oedema in 15 (52%), and cardiac arrest in 10 (35%) patients, respectively. Lesion location was ostial in 7 (25%), body in 8 (29%), and distal in 13 (46%) patients, respectively. Angiographic success was achieved in 24 patients (83%). Stents were deployed in 27 patients (96%); drug-eluting stents in 11 patients (39%). No patient required in-hospital CABG. Cumulative in-hospital mortality was 36%. Univariate predictors of in-hospital mortality included shock, preceding cardiac arrest, and angiographic failure (all P < 0.05). At a mean follow-up of 26 +/- 12 months in hospital survivors, there were two TVR (elective CABGs), one death, and no reinfarctions.
  
  
  CONCLUSIONS
  We report a lower than previously reported in-hospital mortality of 36% in contemporary patients undergoing primary PCI for unprotected LMS thrombosis. Long-term outcomes in hospital survivors appear favorable.
authors.affiliation: MonashHeart, Monash Medical Centre, Melbourne, Australia. sprasad@bigpond.net.au
authors.forename: Sandhir B
authors.initials: SB
authors.lastname: Prasad
authors.forename: Robert
authors.initials: R
authors.lastname: Whitbourn
authors.forename: Yuvaraj
authors.initials: Y
authors.lastname: Malaiapan
authors.forename: Walid
authors.initials: W
authors.lastname: Ahmar
authors.forename: Andrew
authors.initials: A
authors.lastname: MacIsaac
authors.forename: Ian T
authors.initials: IT
authors.lastname: Meredith
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013927:Thrombosis / Q000150:complications*; D016896:Treatment Outcome