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Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
Published on: October 14, 2016
Acute, total occlusion of the left main stem: coronary intervention options, outcomes, and recommendations
István Ferenc Édes1, Zoltán Ruzsa1, Árpád Lux1
1Semmelweis University, Heart and Vascular Center, Budapest, Hungary.
Insights
Acute coronary syndrome patients with unprotected left main stem occlusion face high mortality, especially after CPR. Emergency percutaneous coronary intervention offers successful revascularization with acceptable long-term outcomes for survivors.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Unprotected left main stem (uLMo) occlusion in acute coronary syndrome (ACS) is a critical event associated with high mortality from sudden cardiac death and cardiogenic shock.
- Limited comprehensive data exists on emergent treatment strategies for uLMo in ACS.
Purpose of the Study:
- To evaluate the outcomes of emergency percutaneous coronary intervention (PCI) in patients presenting with ACS and uLMo.
- To assess in-hospital mortality, successful coronary anatomy salvage, and major adverse cardiac events (MACE) at 90 days.
Main Methods:
- Analysis of data from 23 patients undergoing primary PCI for uLMo.
- Primary endpoint: in-hospital death. Secondary endpoints: successful coronary salvage and 90-day MACE.
Main Results:
- Approximately 40% of patients presented after successful cardiopulmonary resuscitation (CPR).
- Successful LM stenting achieved in ~90% of cases; cardiogenic shock (CS) present in >85%.
- In-hospital mortality was 56%, predominantly in patients requiring prior CPR; 6-month MACE rates were 8.7%.
Conclusions:
- ACS with uLMo frequently presents with preceding CPR and severe cardiogenic shock.
- While coronary salvage via PCI is often successful, overall mortality remains high, particularly for patients requiring prior CPR.
- Survivors of uLMo treated with PCI demonstrate acceptable 6-month MACE rates.
Introduction:
Acute, total occlusion of the unprotected left main stem (uLMo) in acute coronary syndrome (ACS) patients is a catastrophic event often accompanied by sudden cardiac death (SCD) and/or cardiogenic shock (CS) with high mortality rates and limited methods of successful treatment. Emergent, surgical and percutaneous revascularization has been reported before, yet comprehensive data remains scarce.
Aim:
To examine emergency percutaneous coronary intervention (PCI) outcomes in ACS cases presenting with uLMo.
Material And Methods:
Data on 23 subjects undergoing primary PCI in uLMo cases were analyzed. The primary end-point was in-hospital death; secondary end-points were successful salvage of coronary anatomy and 90-day major cardiac adverse events (MACE).
Results:
About 40% of LM occlusion cases presented following successful on-site cardio-pulmonary resuscitation (CPR). Of all patients arriving for treatment the occluded LM was successfully opened and stented in ~90% of cases. CS was present in > 85% of cases, and circulatory support in the form of intra-aortic balloon pump and/or extracorporeal membrane oxygenation systems was applied in every eligible case (~80%). The in-hospital death rate was 56%, mostly including individuals requiring prior CPR. At 6 months, additional MACE rates were low at 8.7%.
Conclusions:
We found that uLMo ACS cases often present with preceding CPR and mostly in manifest CS. Coronary salvage is generally successful, yet uLMo even with optimal present day complex treatment yields quite high mortality rates. This is especially true for patients receiving prior CPR. In surviving patients, however, 6-month MACE rates are acceptable.
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