title: Primary percutaneous coronary intervention for unprotected left main disease in patients with acute ST-segment elevation myocardial infarction the AMIS (Acute Myocardial Infarction in Switzerland) plus registry experience.
abstract: OBJECTIVE
  This study sought to assess outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) for unprotected left main (LM) disease.
  
  
  BACKGROUND
  Limited data are available on outcomes in patients with ST-segment elevation myocardial infarction undergoing LM PCI.
  
  
  METHODS
  Of 9,075 patients with ST-segment elevation myocardial infarction enrolled in the AMIS (Acute Myocardial Infarction in Switzerland) Plus registry between 2005 and June 30, 2010, 6,666 underwent primary PCI. Of them, 348 (5.2%; mean age: 63.5 ± 12.6 years) underwent LM PCI, either isolated (n = 208) or concomitant to PCI for other vessel segments (n = 140). They were compared with 6,318 patients (94.8%; mean age: 61.9 ± 12.5 years) undergoing PCI of non-LM vessel segments only.
  
  
  RESULTS
  The LM patients had higher rates of cardiogenic shock (12.2% vs. 3.5%; p < 0.001), cardiac arrest (10.6% vs. 6.3%; p < 0.01), in-hospital mortality (10.9% vs. 3.8%; p < 0.001), and major adverse cardiac and cerebrovascular events (12.4% vs. 5.0%; p < 0.001) than non-LM PCI. Rates of mortality and major adverse cardiac and cerebrovascular events were highest for concurrent LM and non-LM PCI (17.9% and 18.6%, respectively), intermediate for isolated LM PCI (6.3% and 8.3%, respectively), and lowest for non-LM PCI (3.8% and 5.0%, respectively). Rates of mortality and major adverse cardiac and cerebrovascular events for LM PCI were higher than for non-LM multivessel PCI (10.9% vs. 4.9%, p < 0.001, and 12.4% vs. 6.4%, p < 0.001, respectively). LM disease independently predicted in-hospital death (odds ratio: 2.36; 95% confidence interval: 1.34 to 4.17; p = 0.003).
  
  
  CONCLUSIONS
  Emergent LM PCI in the context of acute myocardial infarction, even including 12% cardiogenic shock, appears to have a remarkably high (89%) in-hospital survival. Concurrent LM and non-LM PCI has worse outcomes than isolated LM PCI.
authors.affiliation: Division of Cardiology, CardioCentro Ticino, Lugano, Switzerland. giovanni.pedrazzini@cardiocentro.org
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Pedrazzini
authors.forename: Dragana
authors.initials: D
authors.lastname: Radovanovic
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vassalli
authors.forename: Daniel
authors.initials: D
authors.lastname: Sürder
authors.forename: Tiziano
authors.initials: T
authors.lastname: Moccetti
authors.forename: Franz
authors.initials: F
authors.lastname: Eberli
authors.forename: Philip
authors.initials: P
authors.lastname: Urban
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Hans
authors.initials: H
authors.lastname: Rickli
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D016001:Confidence Intervals; D017023:Coronary Angiography; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors; D012770:Shock, Cardiogenic; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013557:Switzerland; D016896:Treatment Outcome