title: Primary angioplasty in ST-elevation myocardial infarction due to unprotected left-main coronary disease in a high-volume catheterization center without on-site surgery facilities: immediate and medium-term outcome: the STEMI-Placet Registry.
abstract: BACKGROUND
  Very few data have been published for ST-elevation myocardial infarction (STEMI) caused by unprotected left main coronary artery (ULMCA) and very little is known about the results in this subgroup of patients in a hospital with high-volume catheterization laboratories (cath labs) without on-site cardiosurgery.
  
  
  RESULTS
  From January 2004 to December 2009, a total of 38 patients with evolving STEMI and ULMCA as the culprit lesion treated with primary angioplasty were enrolled in our registry. Despite dramatic clinical presentation (73.7% cardiogenic shock, 15.8% cardiac arrest and resuscitation maneuvers, 81.6% additive EuroSCORE >13, and 89.5% distal bifurcation involvement), angiographic success was obtained in 84.2% and final TIMI 3 flow was achieved in 34 (89.5%), while target lesion failure occurred in 47.4% (mostly [42.1%] during the in-hospital phase). Most of the patients discharged from hospital had no events at follow-up (47.4%), and notably no target lesion revascularization was required during the follow-up phase.
  
  
  CONCLUSIONS
  Primary angioplasty in patients presenting with ULMCA as the culprit lesion in a STEMI setting appears to be technically feasible and a good alternative to surgical revascularization. Mortality in this group of patients tends to be high, but lower than mortality of untreated patients; the majority of events are concentrated during the in-hospital phase. Procedural delay related to activation of operator's staff in off-duty hours doesn't correlate with a worse prognosis.
authors.affiliation: Ospedale degli Infermi, ASL TO 3, Cardiology Department, Rivoli (Turin), Italy. gagnora@gmail.com
authors.forename: Andrea
authors.initials: A
authors.lastname: Gagnor
authors.forename: Francesco
authors.initials: F
authors.lastname: Tomassini
authors.forename: Enrico
authors.initials: E
authors.lastname: Romagnoli
authors.forename: Nicolò
authors.initials: N
authors.lastname: Montali
authors.forename: Sara
authors.initials: S
authors.lastname: Giolitto
authors.forename: Emanuele
authors.initials: E
authors.lastname: Tizzani
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Infantino
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Varbella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods*; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications* / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006748:Hospital Departments; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome