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Updated: Jan 28, 2026
Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
Published on: October 14, 2016
Outcome of contemporary unprotected left main percutaneous coronary intervention in patients with acute myocardial
Hong Nyun Kim1,2, Jang Hoon Lee1,2, Bo Eun Park1,2
1Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
Insights
ST-segment elevation myocardial infarction (STEMI) patients with culprit left main coronary artery (LMCA) stenosis face higher mortality and adverse events compared to non-STEMI. Treating non-culprit LMCA stenosis concurrently in STEMI does not improve outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Limited data exist on clinical characteristics and outcomes for left main coronary artery (LMCA) stenosis in ST-segment elevation myocardial infarction (STEMI) versus non-STEMI.
- Understanding differences in culprit vs. non-culprit LMCA stenosis is crucial for optimizing patient management.
Purpose of the Study:
- To compare treatment patterns and clinical outcomes between STEMI and non-STEMI patients with culprit and non-culprit LMCA stenosis.
- To identify factors influencing outcomes in LMCA stenosis based on STEMI status.
Main Methods:
- Retrospective analysis of 572 patients with LMCA stenosis from the Korean Acute Myocardial Infarction Registry-National Institute of Health.
- Comparison of major adverse cardiac and cerebrovascular events (MACCE) between STEMI and non-STEMI groups, stratified by culprit and non-culprit LMCA stenosis.
- Definition of MACCE included all-cause death, nonfatal myocardial infarction, repeat revascularization, cerebrovascular accident, rehospitalizations, and stent thrombosis.
Main Results:
- STEMI patients with culprit LMCA stenosis exhibited significantly higher rates of cardiogenic shock, mechanical hemodynamic support use, in-hospital mortality, and 3-year MACCE compared to non-STEMI.
- Intravascular ultrasound use was associated with improved outcomes in culprit LMCA stenosis.
- No significant differences in MACCE were observed between STEMI and non-STEMI for non-culprit LMCA stenosis, and concurrent PCI for non-culprit LMCA stenosis did not improve MACCE in STEMI.
Conclusions:
- Percutaneous coronary intervention (PCI) for culprit LMCA stenosis remains challenging in both STEMI and non-STEMI, even with hemodynamic support.
- Concurrent PCI for non-culprit LMCA stenosis in STEMI patients does not confer additional benefits regarding MACCE.
Background:
Limited data are available on clinical characteristics and outcomes in patients with culprit or non-culprit left main coronary artery (LMCA) stenosis between ST-segment elevation myocardial infarction (STEMI) and non-STEMI.
Methods:
This study aimed to compare treatment pattern and outcome between STEMI and non-STEMI according to culprit and non-culprit LMCA stenosis. We examined 572 patients with LMCA stenosis from the Korean Acute Myocardial Infarction Registry-National Institute of Health database. Major adverse cardiac and cerebrovascular events (MACCE) were defined as all-cause death, nonfatal myocardial infarction (MI), repeat revascularization, cerebrovascular accident, rehospitalizations, and stent thrombosis.
Results:
In patients with culprit LMCA stenosis, cardiogenic shock (50.5% vs. 12.1%; P < 0.001) and use of mechanical hemodynamic support (48.5% vs. 11.0%; P < 0.001) were significantly greater in STEMI than in non-STEMI. In-hospital mortality (32.3% vs. 8.1%, P < 0.001) and 3-year MACCE (56.6% vs. 42.2%; log-rank P = 0.003) were significantly higher in STEMI. Intravascular ultrasound improved outcomes of culprit LMCA stenosis (23.1% vs. 68.1%, log-rank P = 0.001). Acute kidney injury, multiple organ failure, and cardiopulmonary resuscitation were independently associated with MACCE in STEMI. In patients with non-culprit LMCA stenosis, there were no significant differences in MACCE between STEMI and non-STEMI (31.3% vs. 34.8%, log-rank P = 0.530). Concurrent percutaneous coronary intervention (PCI) for non-culprit LMCA stenosis during PCI for other culprit vessel segments did not improve MACCE in STEMI (29.5% vs. 32.9%; log-rank P = 0.660).
Conclusions:
PCI for culprit LMCA stenosis is challenging in both STEMI and non-STEMI despite appropriate mechanical hemodynamic support. Concurrent PCI for non-culprit LMCA stenosis in STEMI does not improve MACCE.
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