title: Percutaneous coronary intervention of unprotected left main coronary artery disease as culprit lesion in patients with acute myocardial infarction.
abstract: OBJECTIVE
  This study sought to evaluate short- and long-term outcomes of patients undergoing emergency percutaneous coronary intervention (PCI) for acute myocardial infarction due to a culprit lesion in an unprotected left main coronary artery.
  
  
  METHODS
  In this retrospective, 2-center, international observational study, 5,261 patients were admitted between February 2005 and December 2008 with acute myocardial infarction and treated with PCI; of these, 1,277 were ST-segment elevation myocardial infarction and 3,984 non-ST-segment elevation myocardial infarction. We identified 48 patients among this cohort who underwent emergency PCI to an unprotected left main coronary artery culprit lesion.
  
  
  RESULTS
  Mean age was 70 ± 12.5 years, and 45% of the patients presented with ST-segment elevation myocardial infarction or new left bundle branch block. Cardiogenic shock was present in 45%, and distal left main coronary artery disease was present in 71% of patients. Angiographic procedural success was achieved in 92% of patients. Overall in-hospital mortality was 21%, due in all cases to refractory, multiorgan failure. Twenty-five percent experienced major adverse cardiac events, defined as death, myocardial infarction, stent thrombosis, and target vessel revascularization. In patients presenting in cardiogenic shock, in-hospital mortality was 32%. At 1-year follow-up, in-hospital survivors had a mortality rate of 10.5%, whereas 18.4% experienced subsequent major adverse cardiac events. Long-term prognosis was excellent in hospital survivors with a 1-year survival rate of 89.5%.
  
  
  CONCLUSIONS
  Patients with acute myocardial infarction and thrombosis of the unprotected left main coronary artery are a high-risk subgroup with a substantial mortality, particularly if they present in cardiogenic shock. We demonstrate that in these patients, PCI is a feasible treatment option associated with reasonably good outcomes. Long-term prognosis is excellent in hospital survivors with an 89.5% survival rate at 1 year.
authors.affiliation: Department of Interventional Cardiology, San Giovanni-Addolorata Hospital, Rome, Italy. ppplsn58m09h501h@libero.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pappalardo
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Imola
authors.forename: Vito
authors.initials: V
authors.lastname: Ramazzotti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Manzoli
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
authors.forename: Magdi
authors.initials: M
authors.lastname: El-Omar
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000295:instrumentation / Q000379:methods*; D002037:Bundle-Branch Block; D000077144:Clopidogrel; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D004632:Emergency Medical Services; D005260:Female; D006305:Health Status Indicators; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D012770:Shock, Cardiogenic; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine