Key result
Primary coronary angioplasty for left main AMI achieves ~91% success despite high in-hospital mortality.
Observational (n=22)
Percutaneous mechanical intervention for left main disease complicated by AMI and cardiogenic shock is feasible, though associated with high in-hospital mortality (50%) due to refractory shock.
High mortality warrants caution in left main AMI; leaves open optimal adjunctive strategies for prospective trials.
Previous studies have shown a benefit of a strategy of direct angioplasty and stenting in patients with acute myocardial infarction (AMI) complicated by early cardiogenic shock. However, few data exist for the subset of patients with left main trunk disease complicated by AMI and cardiogenic shock. We performed an analysis of patients with AMI who underwent mechanical intervention between January 1995 and December 2000. Out of 1,433 patients with ST segment elevation AMI treated with primary coronary angioplasty (PTCA), 22 patients (1.5%) had left main disease (LMD) as the culprit lesion. Baseline characteristics were age, 66 +/- 11 years; female gender, 9%; diabetes, 14%; previous myocardial infarction, 14%; mean systolic blood pressure, 77 +/- 24 mm Hg; time to treatment, 4.8 +/- 2.2 hr; TIMI 0-1, 77%; collateral flow (Rentrop grade >or= 2) 9%. The primary success rate was 91%. Primary stenting was performed in 17 patients (77%). The in-hospital mortality rate was 50%. All deaths were due to refractory shock. The 6-month survival rate was 41% +/- 1%, while the event-free survival rate was 27% +/- 10%. At 6-month follow-up, the mortality rate increased to 59%; the target vessel revascularization rate was 14%. A percutaneous mechanical intervention strategy in patients with left main disease complicated by AMI is feasible and effective, and patients discharged alive have a good mid-term prognosis.
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Neri et al. (2002) conducted an observational in Left main coronary disease complicated by acute myocardial infarction (n=22). Primary coronary angioplasty (PTCA) was evaluated on Primary success rate. Primary coronary angioplasty in patients with left main disease complicated by AMI achieved a 91% primary success rate, though in-hospital mortality remained high at 50%.
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