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Primary percutaneous coronary intervention for acute myocardial infarction caused by unprotected left main stem

Sandhir B Prasad1, Robert Whitbourn, Yuvaraj Malaiapan

  • 1MonashHeart, Monash Medical Centre, Melbourne, Australia. sprasad@bigpond.net.au

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|February 13, 2009
PubMed

Insights

Percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) due to left main stem (LMS) thrombosis has limited outcome data. This study found a 36% in-hospital mortality, with favorable long-term outcomes for survivors.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Limited data exists on outcomes for percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) caused by left main stem (LMS) thrombosis.
  • Unprotected LMS thrombosis presents a significant clinical challenge.

Purpose of the Study:

  • To determine clinical features of patients undergoing primary PCI for unprotected LMS thrombosis.
  • To identify correlates of early mortality in this patient group.
  • To assess long-term outcomes in contemporary patients treated with primary PCI for unprotected LMS thrombosis.

Main Methods:

  • Retrospective analysis of 1,115 primary PCI cases, identifying 28 (2.5%) with unprotected LMS culprit lesions.
  • Data collected via institutional databases, patient records, telephone surveys, and angiogram reviews.
  • Follow-up conducted at a mean of 26 months for hospital survivors.

Main Results:

  • The study population (n=28) had a mean age of 68 years, with 76% males and 21% with diabetes.
  • High rates of shock (62%), pulmonary edema (52%), and cardiac arrest (35%) were observed at presentation.
  • In-hospital mortality was 36%, with predictors including shock, preceding cardiac arrest, and angiographic failure. Long-term follow-up showed low rates of adverse events.

Conclusions:

  • Contemporary primary PCI for unprotected LMS thrombosis is associated with a 36% in-hospital mortality, lower than previously reported.
  • Long-term outcomes for patients surviving hospitalization appear favorable, suggesting PCI is a viable treatment option.
Abstract

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