Author + information
- Received February 28, 2011
- Revision received April 13, 2011
- Accepted April 15, 2011
- Published online June 1, 2011.
- Giovanni B. Pedrazzini, MD⁎,⁎ (, )
- Dragana Radovanovic, MD†,
- Giuseppe Vassalli, MD⁎,§,
- Daniel Sürder, MD⁎,
- Tiziano Moccetti, MD⁎,
- Franz Eberli, MD‡,
- Philip Urban, MD∥,
- Stephan Windecker, MD¶,
- Hans Rickli, MD#,
- Paul Erne, MD⁎⁎,
- AMIS Plus Investigators
- ↵⁎Reprint requests and correspondence:
Dr. Giovanni B. Pedrazzini, Division of Cardiology, CardioCentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
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.
- coronary artery disease
- left main coronary artery
- myocardial infarction
- ST-segment elevation myocardial infarction
Dr. Eberli received grant support from Biosensors, Boston Scientific, Terumo, Medtronic, St. Jude Medical; and he is on the advisory board of Cordis (Johnson & Johnson) Co. Dr. Urban is a consultant to Cordis (Johnson & Johnson) and Biosensors. Dr. Windecker received research grants from Abbott, Cordis, Medtronic, Biosensors, and Boston Scientific. All other authors have reported that they have no relationships to disclose. George D. Dangas, MD, PhD, served as Guest Editor for this paper.
- Received February 28, 2011.
- Revision received April 13, 2011.
- Accepted April 15, 2011.
- American College of Cardiology Foundation