Emergency percutaneous coronary intervention in unprotected left main coronary arteries. Predictors of mortality and impact of cardiogenic shock.
OBJECTIVE
Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) disease may be essential following acute myocardial infarction (AMI). However, few data are available on the use of emergency PCI in unprotected LMCAs outside of clinical trials. The objective of this study was to determine the frequency of in-hospital mortality, its predictors and its association with cardiogenic shock, and long-term outcomes in patients with unprotected LMCA disease who undergo emergency PCI because of AMI.


METHODS
The study included 71 consecutive patients who underwent emergency angioplasty of the LMCA and who were followed up clinically.


RESULTS
Overall, 42 patients (59%) had ST-elevation AMI and 47 (66%) had cardiogenic shock or developed it during PCI. Eleven patients (16%) died in the catheterization laboratory and 33 (47%) died during hospitalization. Inhospital mortality was similar in those with and without evidence of ST-segment elevation on ECG (48% vs. 45%; P=1). Multivariate analysis showed that the predictors of in-hospital mortality were cardiogenic shock (odds ratio [OR]=4.5; 95% confidence interval [CI], 1.1-18) and incomplete revascularization (OR=5.1; 95% CI, 1.0-26). After discharge, 39 patients were followed up for a median of 32 months. Mortality in the first year was 10%.


CONCLUSIONS
Emergency PCI is a viable therapeutic option for AMI due to unprotected LMCA disease. However, in-hospital mortality is high, regardless of ST-segment elevation, particularly if there is cardiogenic shock or complete revascularization has not been achieved.
Hurtado
José
J
Servicio de Cardiología, Sección de Hemodinámica, Hospital Virgen de la Arrixaca, Murcia, España. josehurtadomartinez@yahoo.es
Pinar Bermúdez
Eduardo
E
Redondo
Belén
B
Lacunza Ruiz
Javier
J
Gimeno Blanes
Juan Ramón
JR
García de Lara
Juan
J
Valdesuso Aguilar
Raúl
R
Teruel
Francisca
F
Valdés Chavarri
Mariano
M
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000150:complications / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D004638:Emergency Treatment; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications; D012770:Shock, Cardiogenic / Q000150:complications