title: Early and mid-term clinical outcome of emergency PCI in patients with STEMI due to unprotected left main coronary artery disease.
abstract: OBJECTIVE
  Evaluation of acute and mid-term outcomes of patients with ST-elevation myocardial infarction (STEMI) undergoing emergency PCI due to unprotected left main coronary artery (ULMCA) disease.
  
  
  BACKGROUND
  STEMI patients due to ULMCA disease represent a rare, high risk group. Percutaneous coronary intervention (PCI) may be the preferred strategy of myocardial revascularization but there are few data about this topic.
  
  
  METHODS
  We analyzed 30-day and mid-term mortality of 58 patients with STEMI and ULMCA disease as culprit lesion treated in our centre by emergency PCI between 2000 to 2010.
  
  
  RESULTS
  Mean age was 67.3 ± 11.5 years. Thirty (51.7%) patients had cardiogenic shock on admission. PCI success was achieved in 54 patients (93.1%). Mean follow-up was 15.8 ± 10.9 months (median 14, range 6-45). Thirty-day and mid-term mortality rates were 39.7% and 44%. Backward binary logistic regression model identified cardiogenic shock at presentation (OR 12.6, 95% CI 2.97-53.6, P < 0.001), age ≥75 years (OR 5.9, 95% CI 1.3-26.5, P = 0.019) and post-PCI TIMI flow grade <3 (OR 2.9, 95% CI 1.8-5.7 P = 0.02) as independent predictors of 30-day mortality. Cox proportional hazard ratio (HR) identified shock at presentation (HR 5.2, 95% CI 1.8-14.3, P < 0.002), age ≥75 years (HR 3.9, 95% CI 1.8-8.7, P < 0.001), post-PCI TIMI flow grade <3 (HR 4.9, 95% CI 1.6-14.6; P < 0.005) as independent predictors of mid-term mortality.
  
  
  CONCLUSIONS
  In patients with STEMI and ULMCA as culprit lesion, emergency PCI is a valuable therapeutic strategy. Early and mid-term survival depends on cardiogenic shock, advanced age, and PCI failure. Patients surviving the first month have good mid-term prognosis.
authors.affiliation: UO Cardiologia Interventistica, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy. parma777@yahoo.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Parma
authors.forename: Rosario
authors.initials: R
authors.lastname: Fiorilli
authors.forename: Francesco
authors.initials: F
authors.lastname: DE Felice
authors.forename: Francesco
authors.initials: F
authors.lastname: Chini
authors.forename: Paolo
authors.initials: P
authors.lastname: Giorgi Rossi
authors.forename: Piero
authors.initials: P
authors.lastname: Borgia
authors.forename: Marco Stefano
authors.initials: MS
authors.lastname: Nazzaro
authors.forename: Carmine
authors.initials: C
authors.lastname: Musto
authors.forename: Gabriella
authors.initials: G
authors.lastname: Guasticchi
authors.forename: Roberto
authors.initials: R
authors.lastname: Violini
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome