title: Clinical outcomes after percutaneous or surgical revascularisation of unprotected left main coronary artery-related acute myocardial infarction: a single-centre experience.
abstract: OBJECTIVE
  We evaluated 30-day and 1-year clinical outcomes after percutaneous or surgical coronary revascularisation in patients with unprotected left main coronary artery (ULMCA)-related acute myocardial infarction (AMI).
  
  
  METHODS
  Single-centre registry.
  
  
  METHODS
  Between January 1998 and December 2008, 84 patients with ULMCA-related AMI underwent revascularisation treatment in our institution (55 underwent percutaneous coronary intervention (PCI), 29 underwent coronary artery bypass graft surgery (CABG)).
  
  
  METHODS
  One-year clinical follow-up was obtained for all patients. Univariable and multivariable analyses were performed to find predictors for 30-day mortality and treatment allocation.
  
  
  RESULTS
  In the PCI-group, all-cause mortality was 64% at 30 days and 69% at 1 year. In the CABG-group, this was 24% at 30 days and 1 year. Independent predictors of 30-day mortality were cardiogenic shock (HR 2.83), thrombolysis in MI (TIMI) 0/1 flow (HR 2.27) and diabetes mellitus (HR 2.65). Treatment allocation to PCI was primarily determined by TIMI 0/1 flow on baseline angiogram (OR 150). In patients with TIMI 2/3 flow on initial angiogram, treatment allocation was determined by presentation with cardiogenic shock (OR 5.61), year of inclusion (OR 1.72), and distal/bifurcation disease (OR 0.11).
  
  
  CONCLUSIONS
  Thirty-day mortality was high in patients presenting with an ULMCA-related AMI, both in the PCI as in the CABG-treatment group. Presentation with cardiogenic shock, TIMI 0/1 flow on initial angiogram and diabetes mellitus were independently predicting of 30-day mortality, whereas treatment allocation was primarily determined by presentation with TIMI 0/1 flow.
authors.affiliation: Department of Cardiology, Academic Medical Center,University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Maik J
authors.initials: MJ
authors.lastname: Grundeken
authors.forename: M Marije
authors.initials: MM
authors.lastname: Vis
authors.forename: Marcel A M
authors.initials: MA
authors.lastname: Beijk
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: Kikkert
authors.forename: Peter
authors.initials: P
authors.lastname: Damman
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: Kloek
authors.forename: Jan
authors.initials: J
authors.lastname: Baan
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.forename: Joanna J
authors.initials: JJ
authors.lastname: Wykrzykowska
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Bas A J M
authors.initials: BA
authors.lastname: de Mol
authors.forename: Jose P S
authors.initials: JP
authors.lastname: Henriques
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D009426:Netherlands / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome