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

被引：51

作者：

Pedrazzini, Giovanni B. ^{[1
]}

Radovanovic, Dragana ^{[2
]}

Vassalli, Giuseppe ^{[1
,4
]}

Suerder, Daniel ^{[1
]}

Moccetti, Liziano ^{[1
]}

Eberli, Franz ^{[3
]}

Urban, Philip ^{[5
]}

Windecker, Stephan ^{[6
]}

Rickli, Hans ^{[7
]}

Erne, Paul ^{[8
]}

机构：

[1] CardioCtr Ticino, Div Cardiol, CH-6900 Lugano, Switzerland

[2] Univ Zurich, Inst Social & Prevent Med, AMIS Plus Data Ctr, CH-8006 Zurich, Switzerland

[3] Stadtspital Triemli, Div Cardiol, Zurich, Switzerland

[4] CHU Vaudois, Div Cardiol, CH-1011 Lausanne, Switzerland

[5] Hop Tour, Cardiovasc Dept, Geneva, Switzerland

[6] Univ Bern, Inselspital, Div Cardiol, CH-3010 Bern, Switzerland

[7] Kantonsspital, Div Cardiol, St Gallen, Switzerland

[8] Luzerner Kantonsspital, Div Cardiol, Luzern, Switzerland

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2011年 / 4卷 / 06期

关键词：

coronary artery disease; left main coronary artery; myocardial infarction; ST-segment elevation myocardial infarction; CARDIOGENIC-SHOCK; ARTERY-DISEASE; BYPASS-SURGERY; TASK-FORCE; REVASCULARIZATION; CARDIOLOGY; STENOSIS; OUTCOMES; METAANALYSIS; GUIDELINES;

D O I：

10.1016/j.jcin.2011.04.004

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 In = 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. (J Am Coll Cardiol Intv 2011;4:627-33) (C) 2011 by the American College of Cardiology Foundation

引用

页码：627 / 633

页数：7

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