Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention - 12/05/18
, Nkechinyere N. Ijioma, MD b, Ryan J. Lennon, MS c, Charanjit S. Rihal, MD b, Malcolm R. Bell, MD b, Jorge A. Brenes-Salazar, MD b, Gurpreet S. Sandhu, MD, PhD b, Rajiv Gulati, MD, PhD b, Patricia A. Pellikka, MD b, Peter M. Pollak, MD a, Gary E. Lane, MD a, Dilip P. Pillai, MD a, Freddy Del-Carpio Munoz, MD, MSc b, d, Arashk Motiei, MD b, e, Mandeep Singh, MD bAbstract |
Background |
Patients with acute coronary syndrome (ACS) due to unprotected culprit left main coronary artery disease (LMCAD) treated with percutaneous coronary intervention (PCI) are rare, high-risk, and not represented in trials. Data regarding long term outcome after PCI are limited.
Methods |
Between January 2000 and December 2014, there were 8,794 patients hospitalized with unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) or ST-elevation myocardial infarction (STEMI) treated with PCI at our institution; of these, 83 (0.94%) patients were identified as having culprit LMCAD ACS.
Results |
Of the 83 patients with unprotected LMCAD ACS, 40 patients presented with STEMI and 43 patients presented with UA/NSTEMI. As compared to LM UA/NSTEMI, LM STEMI patients were younger and had less hypertension, with a trend towards greater frequency of cardiogenic shock. Distal LM involvement was common in both groups and did not differ by ACS type. In-hospital mortality was 33% in LM STEMI and 9% in LM UA/NSTEMI (P = .009). Over median follow up of 6.3 years, long term survival rates in both groups were similar (46% for STEMI vs 51% for UA/NSTEMI; P = .50 by log-rank).
Conclusions |
Unprotected culprit LMCAD ACS necessitating PCI is uncommon, occurring in <1% of cases, but is associated with reduced survival, with long term follow-up noting continued and similar risk of death regardless of index ACS type.
Le texte complet de cet article est disponible en PDF.Abbreviations : ACS, CABG, CAD, IABP, LM, MACE, MI, NSTEMI, PCI, STEMI, TVR, UA
Plan
| Relationships with industry: None of the authors have relationships with industry. |
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| Support: This study was supported through the Mayo Clinic Foundation. |
Vol 199
P. 156-162 - mai 2018 Retour au numéro
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