title: Outcomes of primary percutaneous intervention of the unprotected left main coronary artery stenosis in myocardial infarction.
abstract: OBJECTIVE
  The aim of our study was to examine the 30-day and 1-year survival rate for patients undergoing percutaneous coronary artery intervention (PCI) of unprotected left main (ULM) stenosis by the presence (acute myocardial infarction [AMI] group) or absence (non-AMI group) of AMI at the time of hospital admission.
  
  
  METHODS
  We retrospectively reviewed 64 patients undergoing PCI of ULM stenosis at our regional heart institute between 2000 and 2008. Patients had no history of coronary artery bypass grafting.
  
  
  RESULTS
  Thirty-six men and 28 women underwent PCI for ULM stenosis. Overall Kaplan-Meier survival at 30 days and 1 year was 71.5% and 57.8%, respectively. Thirty-three patients (51.6%) presented with AMI. Those with AMI had lower survival at both 30 days (59.2 vs 83.9%; P = 0.04) and 1 year (45.2 vs 70.2%; P = 0.04) compared with those without AMI. Compared with a lesion involving only the ostial/mid LM, diffuse disease (N = 11) was associated with an increased mortality at 1 year (hazard ratio 0.27; 95% confidence interval 0.09-0.79). A stent size >3 mm was associated with lower mortality at 1 year (hazard ratio 0.42; 95% confidence interval 0.19-0.93).
  
  
  CONCLUSIONS
  We found that AMI at presentation was significantly associated with higher mortality in patients undergoing ULM stenting. LM lesion location and stent size were both significantly associated with mortality. ULM stenting is an option in patients who are unable to undergo coronary artery bypass grafting, but patients should understand the overall high risk of mortality, particularly if they present with AMI.
authors.affiliation: Departments of Cardiovascular Services and Internal Medicine, Joan C Edwards Marshall University School of Medicine, Huntington, West Virginia, USA. darrat@marshall.edu
authors.forename: Yousef Hadi
authors.initials: YH
authors.lastname: Darrat
authors.forename: Hany
authors.initials: H
authors.lastname: Guirgis
authors.forename: Mehiar O
authors.initials: MO
authors.lastname: El-Hamdani
authors.forename: Silvestre
authors.initials: S
authors.lastname: Cansino
authors.forename: Todd W
authors.initials: TW
authors.lastname: Gress
authors.forename: Mark
authors.initials: M
authors.lastname: Studeny
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D023921:Coronary Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome