title: Outcomes of primary percutaneous coronary intervention for acute myocardial infarction with unprotected left main coronary artery occlusion.
abstract: BACKGROUND
  We determined the in-hospital and the long-term outcomes of primary percutaneous coronary intervention (PCI) for acute left main coronary artery (LMCA) occlusion.
  
  
  METHODS
  Between 1988 and 2009, 72 patients with acute myocardial infarction (AMI) underwent primary PCI for unprotected LMCA occlusion. The short- and the long-term outcomes of primary PCI in these patients were retrospectively evaluated.
  
  
  RESULTS
  Upon arrival, cardiogenic shock was observed in 33 (46%) patients and cardiopulmonary arrest (CPA) in 12 (17%). Twenty-three (32%) required extracorporeal life support and 64 (89%) intra-aortic balloon pumping. Although successful reperfusion was achieved in 60 (83%) patients, in-hospital death was observed in 32 (44%). Multivariate analysis revealed predictors of in-hospital death to be CPA on arrival (RR, 7.05; 95% CI: 1.28-39.0; P = 0.025). During 1.7 ± 2.9 years of follow-up, 10 of the 40 hospital survivors died. All presenting CPA on arrival died within 2 years. Although the estimated survival of the all study patients was only 26.2% at 8 years by the Kaplan-Meier methods, those without shock/CPA on arrival showed nearly flat survival curve after 4 years.
  
  
  CONCLUSIONS
  Despite performance of primary PCI, patients with AMI due to LMCA occlusion were associated with >50% in-hospital mortality. Hemodynamic deficit upon arrival was the major determinant of their poor hospital outcomes. The hospital survivors, however, were associated with favorable long-term outcomes.
authors.affiliation: Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Izumikawa
authors.forename: Shingo
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takeshita
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takahashi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D054059:Coronary Occlusion / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018572:Disease-Free Survival; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome