Abstract

Background: The characteristics and in-hospital outcomes of PCI for LM AMI have not been studied in a large patient population

Objectives: To describe the incidence, characteristics, in-hospital outcomes and prognostic determinants of percutaneous coronary interventions (PCI) for acute myocardial infarction (AMI) due to unprotected left main coronary artery UPLMCA lesions.

Methods: The characteristics and in-hospital outcomes of PCI for LM AMI were studied in the CathPCI Registry® between 2004 and 2008.

Results: 434 patients underwent PCI for ST elevation MI (STEMI) and 387 patients underwent PCI for Non STEMI due UPLMCA lesions. Cardiogenic shock and class 4 NYHA were present in 66.4% and 74.9% of patients with STEMI respectively compared with 31.9% and 51.7% of patients with NSTEMI. The in-hospital mortality rate was 58% in the UPLMCA STEMI patients and 28% in the UPLMCA NSTEMI patients compared to 19% in a cohort of 116 patients with protected LMCA (PLMCA) STEMI and 6% in a cohort of 610 patients with PLMCA NSTEMI PCIs. Significant variables associated with in-hospital mortality were age/10 years increase (odds ratio [OR]=1.2; 95% confidence interval [CI]: 1.02-1.4), primary PCI (OR=0.6; CI: 0.4-0.97), GFR/10 unit increase (OR=0.9; CI: 0.8-0.97), UPLMCA NSTEMI (OR=2.6; CI: 1.5-4.2), UPLMCA STEMI (OR=5.0; CI: 3.0-8.4), cardiogenic shock (OR=7.5; CI: 5.2-10.8), pre PCI IABP placement (OR=2.3; CI: 1.1-4.7), salvage PCI (OR=4.3; CI: 2.3-8.1), and pre PCI TIMI flow 0/1 (OR=2.3; CI: 1.6-3.3).

Conclusion: PCI for UPLMCA AMI carries a very high in-hospital mortality rate, particularly in patients presenting with STEMI and cardiogenic shock.

Keywords: PCI; Acute myocardial infarction; Left main