Emergency percutaneous coronary intervention in unprotected left main coronary arteries. Predictors of mortality and impact of cardiogenic shock
| Autor: | Eduardo Pinar Bermúdez, José Hurtado, Javier Lacunza Ruiz, Juan Ramón Gimeno Blanes, Mariano Valdés Chávarri, Francisca Teruel, Belén Redondo, Juan García de Lara, Raúl Valdesuso Aguilar |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Shock Cardiogenic Coronary Artery Disease Revascularization Coronary artery disease Internal medicine Angioplasty medicine Humans cardiovascular diseases Myocardial infarction Hospital Mortality Angioplasty Balloon Coronary Emergency Treatment Aged business.industry Cardiogenic shock Percutaneous coronary intervention General Medicine medicine.disease Coronary arteries medicine.anatomical_structure Conventional PCI Cardiology Female business |
| Zdroj: | Revista espanola de cardiologia. 62(10) |
| ISSN: | 1579-2242 |
| Popis: | Introduction and objectives Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) disease may be essential following acute myocardial infarction (AMI). However, few data are available on the use of emergency PCI in unprotected LMCAs outside of clinical trials. The objective of this study was to determine the frequency of in-hospital mortality, its predictors, and its association with cardiogenic shock, and long-term outcomes in patients with unprotected LMCA disease who undergo emergency PCI because of AMI. Methods The study included 71 consecutive patients who underwent emergency angioplasty of the LMCA and who were followed up clinically. Results Overall, 42 patients (59%) had ST-elevation AMI and 47 (66%) had cardiogenic shock or developed it during PCI. Eleven patients (16%) died in the catheterization laboratory and 33 (47%) died during hospitalization. Inhospital mortality was similar in those with and without evidence of ST-segment elevation on ECG (48% vs 45%; P =1). Multivariate analysis showed that the predictors of in-hospital mortality were cardiogenic shock (odds ratio [OR] =4.5; 95% confidence interval [CI], 1.1-18) and incomplete revascularization (OR=5.1; 95% CI, 1.0-26). After discharge, 39 patients were followed up for a median of 32 months. Mortality in the first year was 10%. Conclusions Emergency PCI is a viable therapeutic option for AMI due to unprotected LMCA disease. However, in-hospital mortality is high, regardless of STsegment elevation, particularly if there is cardiogenic shock or complete revascularization has not been achieved. |
| Databáze: | OpenAIRE |
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