Primary percutaneous coronary intervention for acute myocardial infarction caused by unprotected left main stem thrombosis

BACKGROUND: There is a paucity of data on outcomes in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) caused by left main stem (LMS) thrombosis. OBJECTIVES: We sought to determine (i) the clinical features, (ii) correlates of early mortality, and (iii) long-term outcomes in contemporary patients undergoing primary PCI for unprotected LMS thrombosis. METHODS: From 1,115 consecutive primary PCI cases at two tertiary referral centers between January 2004 and September 2007, 28 cases (2.5%) with unprotected LMS culprit lesions were identified. Data were obtained from review of institutional databases, folder audit, telephone survey of patients, and independent review of angiograms. RESULTS: The mean age of patients was 68 +/- 14 years. Males comprised 76%, and 21% had diabetes. Significant morbidity was noted at presentation: shock in 18 (62%), pulmonary oedema in 15 (52%), and cardiac arrest in 10 (35%) patients, respectively. Lesion location was ostial in 7 (25%), body in 8 (29%), and distal in 13 (46%) patients, respectively. Angiographic success was achieved in 24 patients (83%). Stents were deployed in 27 patients (96%); drug-eluting stents in 11 patients (39%). No patient required in-hospital CABG. Cumulative in-hospital mortality was 36%. Univariate predictors of in-hospital mortality included shock, preceding cardiac arrest, and angiographic failure (all P < 0.05). At a mean follow-up of 26 +/- 12 months in hospital survivors, there were two TVR (elective CABGs), one death, and no reinfarctions. CONCLUSION: We report a lower than previously reported in-hospital mortality of 36% in contemporary patients undergoing primary PCI for unprotected LMS thrombosis. Long-term outcomes in hospital survivors appear favorable.