Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention

Autor: Dilip P. Pillai, S. Michael Gharacholou, Gary E. Lane, Charanjit S. Rihal, Malcolm R. Bell, Gurpreet S. Sandhu, Freddy Del-Carpio Munoz, Nkechinyere N. Ijioma, Patricia A. Pellikka, Jorge A. Brenes-Salazar, Mandeep Singh, Peter M. Pollak, Ryan J. Lennon, Rajiv Gulati, Arashk Motiei
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
Acute coronary syndrome
Time Factors
medicine.medical_treatment
030204 cardiovascular system & hematology
Coronary Angiography
Culprit
Electrocardiography
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Risk Factors
Internal medicine
Humans
Medicine
Hospital Mortality
Prospective Studies
Registries
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Acute Coronary Syndrome
Aged
medicine.diagnostic_test
business.industry
Unstable angina
Incidence
Cardiogenic shock
Coronary Stenosis
Percutaneous coronary intervention
medicine.disease
Coronary Vessels
United States
Treatment Outcome
surgical procedures
operative
Echocardiography
Conventional PCI
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Zdroj: American Heart Journal. 199:156-162
ISSN: 0002-8703
DOI: 10.1016/j.ahj.2018.02.012
Popis: 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.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.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).Unprotected culprit LMCAD ACS necessitating PCI is uncommon, occurring in1% 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.
Databáze: OpenAIRE
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