Primary percutaneous coronary intervention for unprotected left main disease in patients with acute st-segment elevation myocardial infarction: The AMIS (Acute Myocardial Infarction in Switzerland) plus registry experience

  • G.B. P
  • D. R
  • G. V
  • et al.
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Abstract

Objectives: This study sought to assess outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) for unprotected left main (LM) disease. Background: Limited data are available on outcomes in patients with ST-segment elevation myocardial infarction undergoing LM PCI. Methods: Of 9,075 patients with ST-segment elevation myocardial infarction enrolled in the AMIS (Acute Myocardial Infarction in Switzerland) Plus registry between 2005 and June 30, 2010, 6,666 underwent primary PCI. Of them, 348 (5.2%; mean age: 63.5 +/- 12.6 years) underwent LM PCI, either isolated (n = 208) or concomitant to PCI for other vessel segments (n = 140). They were compared with 6,318 patients (94.8%; mean age: 61.9 +/- 12.5 years) undergoing PCI of non-LM vessel segments only. Results: The LM patients had higher rates of cardiogenic shock (12.2% vs. 3.5%; p < 0.001), cardiac arrest (10.6% vs. 6.3%; p < 0.01), in-hospital mortality (10.9% vs. 3.8%; p < 0.001), and major adverse cardiac and cerebrovascular events (12.4% vs. 5.0%; p < 0.001) than non-LM PCI. Rates of mortality and major adverse cardiac and cerebrovascular events were highest for concurrent LM and non-LM PCI (17.9% and 18.6%, respectively), intermediate for isolated LM PCI (6.3% and 8.3%, respectively), and lowest for non-LM PCI (3.8% and 5.0%, respectively). Rates of mortality and major adverse cardiac and cerebrovascular events for LM PCI were higher than for non-LM multivessel PCI (10.9% vs. 4.9%, p < 0.001, and 12.4% vs. 6.4%, p < 0.001, respectively). LM disease independently predicted in-hospital death (odds ratio: 2.36; 95% confidence interval: 1.34 to 4.17; p = 0.003). Conclusions: Emergent LM PCI in the context of acute myocardial infarction, even including 12% cardiogenic shock, appears to have a remarkably high (89%) in-hospital survival. Concurrent LM and non-LM PCI has worse outcomes than isolated LM PCI. © 2011 American College of Cardiology Foundation.

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G.B., P., D., R., G., V., D., S., T., M., F., E., … H., R. (2011). Primary percutaneous coronary intervention for unprotected left main disease in patients with acute st-segment elevation myocardial infarction: The AMIS (Acute Myocardial Infarction in Switzerland) plus registry experience. JACC: Cardiovascular Interventions. Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States). Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed13&NEWS=N&AN=362002088

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