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Alexandre A, Campinas A, Brochado B, Braga M, Sá‐Couto D, Santos M, Ribeiro D, Brandão M, Silva MP, de Morais GP, Calvão J, Silva JC, Baggen‐Santos R, Luz A, Silveira J, Torres S. Twelve-year trends in unprotected left main coronary artery occlusion: insights from a real-world multicentre study. ESC Heart Fail 2024; 11:1981-1994. [PMID: 38549183 PMCID: PMC11287319 DOI: 10.1002/ehf2.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/10/2023] [Accepted: 12/28/2023] [Indexed: 07/31/2024] Open
Abstract
AIMS Acute myocardial infarction (AMI) resulting from unprotected left main coronary artery (LMCA) occlusion and subtotal occlusion is a life-threatening condition. Although AMI management has improved in the past two decades, there is limited information on recent trends in patient characteristics, management, and outcomes for acute unprotected LMCA-related AMI. This study aims to assess such trends over a 12 year period. METHODS AND RESULTS This retrospective multicentre study includes patients with unprotected LMCA occlusion/subtotal occlusion admitted to three tertiary hospitals between 2008 and 2020. The patients were divided into two groups based on the chronology of presentation: a 'past group' (January 2008 to December 2014) and a 'contemporary group' (January 2015 to December 2020). The study compares clinical characteristics, management approaches, and outcomes between the two groups. The study includes 128 patients, with 51 (40%) in the 'past group' and 77 (60%) in the 'contemporary group'. Baseline risk factors did not show statistically significant differences between the two groups, except for hypertension (49% vs. 74%; P = 0.005). Chest pain was more frequent in the 'past group' (98% vs. 89%; P = 0.014), and a trend towards more cardiac arrests was observed in the 'contemporary group' (18% vs. 31%; P = 0.087). Revascularization type did not differ significantly (P = 0.419), but manual thrombectomy was less frequently used (41% vs. 23%; P = 0.032) and stent implantation showed a trend towards higher rates (66% vs. 78%; P = 0.150) in the 'contemporary cohort'. There was a gradual shift from bare-metal to drug-eluting stents, with a significantly higher percentage of ticagrelor/prasugrel loading in the 'contemporary cohort' (5% vs. 79%; P < 0.001). The use of mechanical circulatory support (MCS), although not statistically significant, was higher among patients in the 'past group' (67% vs. 51%; P = 0.073). The type of MCS differed significantly between groups, with a decrease in intra-aortic balloon pump use (67% vs. 42%; P = 0.005) and an increase in veno-arterial extracorporeal membrane oxygenation (4% vs. 22%; P = 0.005) and Impella system (0% vs. 3%) over time. Survival analysis showed no significant differences (P = 0.599; log-rank test) in all-cause mortality between the different time groups, with the long-term survival rate being approximately 30%. CONCLUSIONS In our real-world population, despite the progressive use of newer drugs and more advanced devices over time, patients with unprotected LMCA occlusion/subtotal occlusion remain a subpopulation with poor prognosis.
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Affiliation(s)
- André Alexandre
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Andreia Campinas
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
| | - Bruno Brochado
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Marta Braga
- Department of CardiologyCentro Hospitalar Universitário de São João (CHUSJ)PortoPortugal
| | - David Sá‐Couto
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Mariana Santos
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Diana Ribeiro
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
| | - Mariana Brandão
- Department of CardiologyCentro Hospitalar de Vila Nova de Gaia e Espinho (CHVNGE)Vila Nova de GaiaPortugal
| | - Marisa Passos Silva
- Department of CardiologyCentro Hospitalar de Vila Nova de Gaia e Espinho (CHVNGE)Vila Nova de GaiaPortugal
| | - Gustavo Pires de Morais
- Department of CardiologyCentro Hospitalar de Vila Nova de Gaia e Espinho (CHVNGE)Vila Nova de GaiaPortugal
| | - João Calvão
- Department of CardiologyCentro Hospitalar Universitário de São João (CHUSJ)PortoPortugal
| | - João Carlos Silva
- Department of CardiologyCentro Hospitalar Universitário de São João (CHUSJ)PortoPortugal
| | - Raquel Baggen‐Santos
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - André Luz
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
- Cardiovascular Research Group, UMIB – Unit for Multidisciplinary Research in Biomedicine, ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - João Silveira
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Severo Torres
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
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Sasaki O, Nishioka T, Inoue Y, Isshiki A, Sasaki H. Predictors of In-Hospital Death in Patients With Acute Myocardial Infarction. Cureus 2023; 15:e43392. [PMID: 37701010 PMCID: PMC10495238 DOI: 10.7759/cureus.43392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVE Factors such as age, vital signs, renal function, Killip class, cardiac arrest, elevated cardiac biomarker levels, and ST deviation predict survival in patients with acute myocardial infarction (AMI). However, the existing risk assessment tools lack comprehensive consideration of catheter-related factors, and short-term prognostic predictors are unknown. This study aimed to clarify in-hospital prognostic predictors in hospitalized patients with AMI. METHODS Five hundred and thirty-six patients who underwent percutaneous coronary intervention (PCI) for AMI were divided into non-survivor (n = 36) and survivor (n = 500) groups. Coronary risk factors, laboratory findings, angiographic findings, and clinical courses were compared between the two groups. Multiple logistic regression was used to analyze in-hospital death in pre- and post-PCI phases. RESULTS In the pre-PCI phase, multiple logistic regression analysis revealed several predictors of in-hospital death, including systolic blood pressure [odds ratio (OR) = 0.985, p = 0.023)], Killip class ≥2 (OR = 14.051, p <0.001), and chronic kidney disease (OR = 4.859, p = 0.040). In the post-PCI phase, multiple logistic regression analysis revealed additional predictors of in-hospital death, including Killip class ≥2 (OR = 5.982, p = 0.039), presence of lesions in the left main trunk (OR = 51.381, p = 0.044), utilization of intra-aortic balloon pumps and percutaneous cardiopulmonary support (OR = 6.141, p = 0.016), and presence of multi-vessel disease (OR = 6.323, p = 0.022). CONCLUSION Predictors of in-hospital death in AMI extend beyond conventional risk factors to include culprit lesions, mechanical support, and multi-vessel disease that manifest post-PCI.
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Affiliation(s)
- Osamu Sasaki
- Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
- Internal Medicine, Mombetsu General Hospital, Mombetsu, JPN
| | - Toshihiko Nishioka
- Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Yoshiro Inoue
- Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Ami Isshiki
- Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Hideki Sasaki
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
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Sasaki O, Sasaki H. Electrocardiographic QRS Findings Upon Admission Can Predict Prognosis of Acute Myocardial Infarction Caused by Occlusion of Left Main Coronary Artery. Cureus 2023; 15:e36435. [PMID: 37090322 PMCID: PMC10115561 DOI: 10.7759/cureus.36435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) caused by left main coronary artery (LMCA) occlusion is associated with a severe clinical course and catastrophic consequences. HYPOTHESIS We sought to clarify ECG predictors of prognosis in AMI caused by LMCA occlusion. METHODS We examined 20 consecutive patients with AMI caused by LMCA occlusion that was treated by primary stenting. The patients were assigned to either a group that survived (S) and was discharged from hospital, or a group that did not survive (NS) and died in hospital. We compared ECG findings upon admission, angiographic findings, laboratory data and clinical outcomes. RESULTS The rate of having Thrombolysis In Myocardial Infarction (TIMI) grade > 2 coronary flow before PCI and of achieving TIMI grade 3 after PCI was significantly lower in the NS than the S group (14.3% vs. 83.3%, p = 0.003 and 35.7% vs. 100%, p = 0.008). The ECG findings showed longer QRS interval in the NS than in the S group (150.5 ± 37.9 vs. 105.2 ± 15.4, p = 0.022). A QRS interval ≥ 120 msec predicted in-hospital mortality with sensitivity, specificity and positive and negative predictive values of 78.5%, 100%, 100% and 66.7%, respectively, in this population. CONCLUSIONS The QRS duration upon admission was a good predictor of in-hospital mortality among patients with AMI caused by LMCA occlusion. This ECG sign could be useful in the emergency clinical setting.
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Affiliation(s)
- Osamu Sasaki
- Internal Medicine, Kouiki Mombetsu Hospital, Mombetsu, JPN
- Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Hideki Sasaki
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
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Beijk MAM, Palacios-Rubio J, Grundeken MJD, Kalkman DN, De Winter RJ. Clinical Outcomes after Percutaneous Coronary Intervention for Cardiogenic Shock Secondary to Total Occlusive Unprotected Left Main Coronary Artery Lesion-Related Acute Myocardial Infarction. J Clin Med 2023; 12:jcm12041311. [PMID: 36835846 PMCID: PMC9959397 DOI: 10.3390/jcm12041311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) with occlusion of an unprotected left main coronary artery (ULMCA) is a rare condition with a high mortality. The literature on clinical outcomes after percutaneous coronary intervention (PCI) for cardiogenic shock secondary to ULMCA-related AMI is scarce. METHODS In this retrospective analysis, all consecutive patients undergoing PCI for cardiogenic shock secondary to total occlusive ULMCA-related AMI were included between January 1998 and January 2017. The primary endpoint was 30-day mortality. The secondary endpoints were long-term mortality and 30-day and long-term major adverse cardiovascular and cerebrovascular events. The differences in clinical and procedural variables were assessed. A multivariable model was created to search for independent predictors of survival. RESULTS Forty-nine patients were included, and the mean age was 62 ± 11 years. The majority of patients suffered cardiac arrest prior or during PCI (51%). Thirty-day mortality was 78%, of which 55% died within 24 h. The median follow-up of patients who survived 30 days (n = 11) was 9.9 years (interquartile range 4.7-13.6), and long-term mortality was 84%. Long-term all-cause mortality was independently associated with cardiac arrest prior or during PCI (hazard ratio [HR] 2.02, 95% confidence interval 1.02-4.01, p = 0.043). Patients who survived to the 30-day follow-up with severe left ventricular dysfunction had a significantly higher risk of mortality compared to patients with moderate to mild dysfunction (p = 0.007). CONCLUSIONS Cardiogenic shock secondary to total occlusive ULMCA-related AMI carries a very high 30-day all-cause mortality. Thirty-day survivors with a severe left ventricular dysfunction have a poor long-term prognosis.
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Affiliation(s)
- Marcel A. M. Beijk
- Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-566-9111
| | - Julián Palacios-Rubio
- Cardiology Department, Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
| | - Maik J. D. Grundeken
- Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Debbie N. Kalkman
- Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Robbert J. De Winter
- Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Alaour B, Onwordi E, Khan A, Menexi C, Carta S, Strike P, Griffiths H, Anantharam B, Hobson A, Dana A. Outcome of left main stem percutaneous coronary intervention in a UK nonsurgical center: A 5-year clinical experience. Catheter Cardiovasc Interv 2021; 99:601-606. [PMID: 33576157 DOI: 10.1002/ccd.29530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/03/2020] [Accepted: 01/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the outcome of unprotected left main stem (LMS) percutaneous coronary intervention (PCI) in a large UK nonsurgical center. BACKGROUND PCI on unprotected LMS is increasingly regarded as a viable alternative to coronary artery bypass grafting (CABG) with comparable outcome and safety profile in select groups. The safety and efficacy of unprotected LMS PCI without on-site surgical back up has not been reported. METHODS Data on all unprotected LMS PCI performed between January 2011 and December 2015, was collected from the local PCI database and electronic patient records. In hospital and 1-year major adverse cardiovascular events (MACE) (all-cause mortality, myocardial infarction [MI], stroke, and target vessel revascularization [TVR]) was recorded. RESULTS 249 patients had unprotected LMS intervention during the study period. 77% of patients (n = 192) were male and mean age was 70 ± 12 years. 31% (n = 78) of cases were elective, 44% (n = 109) NSTEMI, and 25% (n = 62) STEMI. Anatomical distribution: 19% (n = 47) ostial left main, 31% (n = 77) shaft, and 50% (n = 125) bifurcation. The mean SYNTAX score was 24.4 ± 10.6. 22% (n = 55) of patients had severe LV impairment preprocedure and 13% (n = 33) were in cardiogenic shock at presentation. 35% (14%) required IABP support. The vast majority (98.4%) of procedures were successful. No patients required emergency transfer for CABG surgery. There were 25 (10%) in-hospital deaths. 68% of in-hospital deaths occurred in patients undergoing primary PCI for STEMI. 72% of patients who died were in cardiogenic shock at presentation. The 12-month MACE rate was 17.2%. Death occurred in 11.6%, MI in 2.4%, TVR in 2.4%, and stroke in 0.8% of patients. CONCLUSION These results highlight the safety and efficacy of unprotected LMS PCI in a high volume non-surgical center.
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Affiliation(s)
- Bashir Alaour
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Eunice Onwordi
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Asif Khan
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Sabrina Carta
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Philip Strike
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Huw Griffiths
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Brijesh Anantharam
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Alexander Hobson
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Ali Dana
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
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Kim HS, Park KH, Ha SO, Lee SH, Choi HM, Kim SA, Park S, Jo SH, Kim HS, Han SJ, Park WJ. Predictors of survival following veno-arterial extracorporeal membrane oxygenation in patients with acute myocardial infarction-related refractory cardiogenic shock: clinical and coronary angiographic factors. J Thorac Dis 2020; 12:2507-2516. [PMID: 32642158 PMCID: PMC7330300 DOI: 10.21037/jtd.2020.03.51] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aimed to identify the determinant factors of survival in patients with acute myocardial infarction (AMI) and refractory cardiogenic shock (RCS) who underwent veno-arterial extracorporeal membrane oxygenation (ECMO). Methods Sixty-nine consecutive patients with AMI-related RCS were enrolled in the study. They were treated with ECMO and primary percutaneous coronary intervention (PCI). The clinical scores and coronary angiography (CAG) factors related to 100-day survival were evaluated. Results Thirty patients (43.5%) survived for more than 100 days. The CAG showed that 19 (27.5%) patients had left main disease (LMD). There were 17 (24.6%), 27 (39.1%), and 25 (36.3%) patients with one-vessel, two-vessel, and three-vessel disease, respectively. There were significant differences between the survivors and non-survivors in the simplified acute physiology score II (SAPSII) (65.4±17.2 vs. 83.1±13.0, P<0.001), sepsis-related organ failure assessment score (SOFA) (10.4±2.7 vs. 12.3±2.5, P=0.004), survival after veno-arterial extracorporeal membrane oxygenation score (SAVE) (-4.4±4.3 vs. -8.4±3.1, P<0.001), CPR time (15.8±16.6 vs. 30.0±29.5, P=0.048), LMD [4 (13.3%) vs. 15 (38.5%), P=0.029], and number of coronary artery disease (NCAD) (P<0.001). Multivariate logistic regression analysis showed that NCAD (OR 3.788, P=0.008) was one of the independent predictors of mortality. The ROC analysis showed that SAPSII (AUC 0.786, P<0.001), SOFA (AUC 0.715, P=0.002), and SAVE (AUC 0.766, P<0.001) equally predict mortality. The combined NCAD parameters more accurately predicted mortality and differences in the AUC values (d-AUC) between SAPSII plus NCAD vs. SAPSII (d-AUC 0.073, z=2.256, P=0.024), SOFA plus NCAD vs. SOFA (d-AUC 0.058, z=2.773, P=0.006), and SAVE plus NCAD vs. SAVE (d-AUC 0.036, z=2.332, P=0.020). Conclusions The SAPSII, SOFA, and SAVE scores predict the prognosis of ECMO-treated AMI patients with RCS. The CAG findings reinforce the predictive power of each score.
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Affiliation(s)
- Hyoung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi, Korea
| | - Kyoung-Ha Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
| | - Sang Ook Ha
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi, Korea
| | - Sun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi, Korea
| | - Hong-Mi Choi
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
| | - Sung-Ai Kim
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
| | - Sunghoon Park
- Department of Pulmonary and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi, Korea
| | - Sang Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
| | - Hyun-Sook Kim
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
| | - Sang Jin Han
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
| | - Woo Jung Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Anyang, Gyeonggi, Korea
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Does stress hyperglycemia affect mortality? Acute myocardial infarction - case control study. ACTA ACUST UNITED AC 2019; 4:e201-e207. [PMID: 31538125 PMCID: PMC6749178 DOI: 10.5114/amsad.2019.87303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/18/2019] [Indexed: 11/28/2022]
Abstract
Introduction We aimed to investigate the effect of stress (acute) hyperglycemia in patients with acute coronary syndrome who had not been previously diagnosed with diabetes mellitus (DM) on the prognosis of the disease in terms of mortality. Material and methods Patients who were admitted to the Adana Numune Training and Research Hospital Emergency Service Clinic between August 2010 and August 2013 and whose plasma blood glucose level was over 140 mg/dl at the time of admission but were not previously diagnosed with DM, who were over the age of 18 and considered to have acute myocardial infarction were included. Results A total of 259 patients whose data were fully attainable were included in the study. 80.3% (n = 208) of the patients were male and 19.7% (n = 41) were female. Non-ST elevation myocardial infarction was found in 71.6%, ST elevation myocardial infarction was found in 28.4% of the patients with stress hyperglycemia. It was determined that 10.1% of patients with stress-related hyperglycemia and 1.3% of patients without stress-related hyperglycemia had died. Conclusions The plasma blood glucose level at presentation of patients diagnosed with acute myocardial infarction at the emergency room is associated with early in-hospital mortality.
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Rigatelli G, Zuin M, Dinh H, Giatti S, Nguyen VT, Maddali N, Dell'Avvocata F, Daggubati R. Long-Term Outcomes of Left Main Bifurcation Double Stenting in Patients with STEMI and Cardiogenic Shock. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:663-668. [DOI: 10.1016/j.carrev.2018.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/17/2018] [Accepted: 09/27/2018] [Indexed: 11/26/2022]
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New Predictors of Early and Late Outcomes after Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Unprotected Left Main Coronary Artery Culprit Lesion. J Interv Cardiol 2019; 2019:8238972. [PMID: 31772547 PMCID: PMC6739789 DOI: 10.1155/2019/8238972] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 03/04/2019] [Indexed: 12/04/2022] Open
Abstract
Objectives The study evaluated the correlation between baseline SYNTAX Score, Residual SYNTAX Score, and SYNTAX Revascularization Index and long-term outcomes in ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) on an unprotected left main coronary artery lesion (UPLMCA). Background Previous studies on primary PCI in UPLMCA have identified cardiogenic shock, TIMI 0/1 flow, and cardiac arrest, as prognostic factors of an unfavourable outcome, but the complexity of coronary artery disease and the extent of revascularization have not been thoroughly investigated in these high-risk patients. Methods 30-day, 1-year, and long-term outcomes were analyzed in a cohort of retrospectively selected, 81 consecutive patients with STEMI, and primary PCI on UPLMCA. Results Cardiogenic shock (p=0.001), age (p=0.008), baseline SYNTAX Score II (p=0.006), and SYNTAX Revascularization Index (p=0.046) were independent mortality predictors at one-year follow-up. Besides cardiogenic shock (HR 3.28, p<0.001), TIMI 0/1 flow (HR 2.17, p=0.021) and age (HR 1.03, p=0.006), baseline SYNTAX Score II (HR 1.06, p=0.006), residual SYNTAX Score (HR 1.03, p=0.041), and SYNTAX Revascularization Index (HR 0.9, p=0.011) were independent predictors of mortality at three years of follow-up. In patients with TIMI 0/1 flow, the presence of Rentrop collaterals was an independent predictor for long-term survival (HR 0.24; p=0.049). Conclusions In this study, the complexity of coronary artery disease and the extent of revascularization represent independent mortality predictors at long-term follow-up.
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Liu HW, Han YL, Jin QM, Wang XZ, Ma YY, Wang G, Wang B, Xu K, Li Y, Chen SL. One-year Outcomes in Patients with ST-segment Elevation Myocardial Infarction Caused by Unprotected Left Main Coronary Artery Occlusion Treated by Primary Percutaneous Coronary Intervention. Chin Med J (Engl) 2018; 131:1412-1419. [PMID: 29893357 PMCID: PMC6006809 DOI: 10.4103/0366-6999.233948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Very few data have been reported for ST-segment elevation myocardial infarction (STEMI) caused by unprotected left main coronary artery (ULMCA) occlusion, and very little is known about the results of this subgroup of patients who underwent primary percutaneous coronary intervention (PCI). The aim of this study was to determine the clinical features and outcomes of patients with STEMI who underwent primary PCI for acute ULMCA occlusion. Methods From January 2000 to February 2014, 372 patients with STEMI caused by ULMCA acute occlusion (ULMCA-STEMI) who underwent primary PCI at one of two centers were enrolled. The 230 patients with non-ST-segment elevation MI (NSTEMI) caused by ULMCA lesion (ULMCA-NSTEMI) who underwent emergency PCI were designated the control group. The main indexes were the major adverse cardiac events (MACEs) in-hospital, at 1 month, and at 1 year. Results Compared to the NSTEMI patients, the patients with STEMI had significantly higher rates of Killip class≥III (21.2% vs. 3.5%, χ2 = 36.253, P < 0.001) and cardiac arrest (8.3% vs. 3.5%, χ2 = 5.529, P = 0.019). For both groups, the proportions of one-year cardiac death in the patients with a post-procedure thrombolysis in myocardial infarction (TIMI) flow grade<3 were significantly higher than those in the patients with a TIMI flow grade of 3 (STEMI group: 51.7% [15/29] vs. 4.1% [14/343], P < 0.001; NSTEMI group: 33.3% [3/9] vs. 13.6% [3/221], P = 0.001; respectively]. Landmark analysis showed that the patients in STEMI group were associated with higher risks of MACE (16.7% vs. 9.1%, P = 0.009) and cardiac death (5.4% vs. 1.3%, P = 0.011) compared with NSTEMI patients at 1 month. Meanwhile, in patients with ULMCA, the landmark analysis for incidences of MACE and cardiac death was similar between the STEMI and NSTEMI (all P = 0.72) in the intervals of 1-12 months. However, patients who were diagnosed with STEMI or NSTEMI had no significant difference in reinfarction (all P > 0.05) and TVR (all P > 0.05) in the intervals of 0-1 month as well as 1 month to 1 year. The results of Cox regression analysis showed that the differences in the independent predictors for MACE included the variables of Killip class ≥ III and intra-aortic balloon pump support for the STEMI patients and the variables of previous MI, ULMCA distal bifurcation, and 2-stent for distal ULMCA lesions for the NSTEMI patients. Conclusions Compared to the NSTEMI patients, the patients with STEMI and ULMCA lesions still remain at a much higher risk for adverse events at 1 year, especially on 1 month. If a successful PCI procedure is performed, the 1-year outcomes in those patients might improve.
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Affiliation(s)
- Hai-Wei Liu
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Ya-Ling Han
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Quan-Min Jin
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Xiao-Zeng Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Ying-Yan Ma
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Geng Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Bin Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Kai Xu
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Yi Li
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing, Jiangsu 210006, China
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Xu L, Sun H, Wang LF, Yang XC, Li KB, Zhang DP, Wang HS, Li WM. Long-term prognosis of patients with acute myocardial infarction due to unprotected left main coronary artery disease: a single-centre experience over 14 years. Singapore Med J 2017; 57:396-400. [PMID: 27439434 DOI: 10.11622/smedj.2016121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Acute myocardial infarction (AMI) due to unprotected left main coronary artery (ULMCA) disease is clinically catastrophic although it has a low incidence. Studies on the long-term prognosis of these patients are rare. METHODS From January 1999 to September 2013, 55 patients whose infarct-related artery was the ULMCA were enrolled. Clinical, angiographic and interventional data was collected. Short-term and long-term clinical follow-up results as well as prognostic determinants during hospitalisation and follow-up were analysed. RESULTS Cardiogenic shock (CS) occurred in 30 (54.5%) patients. During hospitalisation, 22 (40.0%) patients died. Multivariate logistic regression analysis showed that CS (odds ratio [OR] 5.86; p = 0.03), collateral circulation of Grade 2 or 3 (OR 0.14; p = 0.02) and final flow of thrombolysis in myocardial infarction (TIMI) Grade 3 (OR 0.05; p = 0.03) correlated with death during hospitalisation. 33 patients survived to discharge; another seven patients died during the follow-up period of 44.6 ± 31.3 (median 60, range 0.67-117.00) months. The overall mortality rate was 52.7% (n = 29). Kaplan-Meier analysis showed that the total cumulative survival rate was 30.7%. Cox multivariate regression analysis showed that CS during hospitalisation was the only predictor of overall mortality (hazard ratio 4.07, 95% confidence interval 1.40-11.83; p = 0.01). CONCLUSION AMI caused by ULMCA lesions is complicated by high incidence of CS and mortality. CS, poor collateral blood flow and failure to restore final flow of TIMI Grade 3 correlated with death during hospitalisation. CS is the only predictor of long-term overall mortality.
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Affiliation(s)
- Li Xu
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hao Sun
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Le-Feng Wang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xin-Chun Yang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kui-Bao Li
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Da-Peng Zhang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hong-Shi Wang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wei-Ming Li
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Shikuma A, Shiraishi J, Okawa K, Yashige M, Shoji K, Ito D, Kimura M, Kishita E, Nakagawa Y, Hyogo M, Takahashi A, Sawada T. Primary Percutaneous Coronary Intervention Followed by Valve Surgery for Acute Coronary Syndrome at Left Main Trunk Complicated With Severe Aortic Stenosis. Int Heart J 2017; 58:125-130. [PMID: 28100876 DOI: 10.1536/ihj.16-186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An 89-year-old woman appeared to have acute coronary syndrome at the left main trunk (LMT) complicated with severe aortic stenosis, moderate-severe mitral regurgitation, depressed left ventricular (LV) function, and multivessel disease. Because of sustained hypotension even under intra-aortic balloon pumping support during emergency coronary angiograhy, we performed primary percutaneous coronary intervention solely for the LMT lesion using a bare metal stent, leading to recovery from the shock state. On the second hospital day, based on our heart-team consensus, we performed aortic valve replacement and coronary artery bypass grafting surgery, and added edge-to-edge repair (Alfieri stitch) of the mitral valve, resulting in complete revascularization and dramatically improved LV function.
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Affiliation(s)
- Akira Shikuma
- Department of Cardiology, Kyoto First Red Cross Hospital
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13
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Chung SY, Tong MS, Sheu JJ, Lee FY, Sung PH, Chen CJ, Yang CH, Wu CJ, Yip HK. Short-term and long-term prognostic outcomes of patients with ST-segment elevation myocardial infarction complicated by profound cardiogenic shock undergoing early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention. Int J Cardiol 2016; 223:412-417. [PMID: 27544596 DOI: 10.1016/j.ijcard.2016.08.068] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study investigated the 30-day and long-term prognostic outcomes in patients with ST-segment elevation myocardial infarction (STEMI) complicated with profound cardiogenic shock (CS) undergoing early routine extracorporeal membrane oxygenator (ECMO)-assisted primary percutaneous coronary intervention (PCI). METHODS Between December 2005 and December 2014, 65 consecutive STEMI patients with profound CS underwent routine ECMO-supported primary PCI. RESULTS The incidences of acute pulmonary edema, respiratory failure with requirement of mechanical ventilatory support upon presentation, and 30-day mortality rate were 100%, 95.4%, and 43.1%, respectively. The duration of hospitalization, mean long-term follow-up, and survival rate were 32.1±53.1 (days), 733.6±986.7 (days), and 32.3%, respectively. The mean APACHE score (32.6±8.3 vs. 28.5±7.5), peak serum creatinine level (4.3±2.4 vs. 1.7±1.2mg/dL), incidences of failed ECMO weaning (57.1% vs. 0%), successful ECMO weaning but in-hospital death (40.0% vs. 0%) were significantly lower in 30-day survivors than those in non-survivors (all p<0.05), whereas final thrombolysis in myocardial infarction (TIMI)-3 flow [53.6% vs. 91.9%] showed an opposite pattern compared to that of APACHE score in the two groups (p<0.02). Multivariate analysis demonstrated that unsuccessful reperfusion, failed ECMO weaning, and peak creatinine level were independent predictors of 30-day mortality (all p<0.01). CONCLUSIONS Early ECMO-supported primary PCI in STEMI patients with profound CS was feasible as a life-saving strategy with acceptable 30-day and long-term prognostic outcomes.
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Affiliation(s)
- Sheng-Ying Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Shen Tong
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jiunn-Jye Sheu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fan-Yen Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Nursing, Asia University, Taichung, Taiwan.
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14
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Ielasi A, Silvestro A, Personeni D, Saino A, Angeletti C, Costalunga A, Tespili M. Outcomes following primary percutaneous coronary intervention for unprotected left main-related ST-segment elevation myocardial infarction. J Cardiovasc Med (Hagerstown) 2016; 16:163-9. [PMID: 24892217 DOI: 10.2459/jcm.0000000000000075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Unprotected left main (ULM) related ST-segment elevation myocardial infarction (STEMI) is a severe event, often leading to circulatory failure and/or sudden cardiac death. Although high-risk ULM thrombosis populations treated by primary percutaneous coronary intervention (PPCI) have been previously described, very little is known regarding the outcomes following PPCI for ULM-related STEMI in a hospital without on-site surgical back-up. METHODS A retrospective cohort analysis was performed on all consecutive patients who underwent PPCI for ULM-related STEMI in a single center. The primary end-point was to assess in-hospital mortality in the overall population and according to the presence/absence of cardiogenic shock at admission. RESULTS Between October 2006 and December 2012, 1094 patients underwent PPCI for STEMI. PPCI for ULM-related STEMI was performed in 34 (3.1%) patients. Among these, 22 (64.7%) were in cardiogenic shock at admission. Baseline mean ejection fraction was lower (P = 0.008), whereas the prevalence of patients with pre-procedural cardiac arrest and Killip Class III-IV was significantly higher in the cardiogenic shock (P = 0.05 and P < 0.001, respectively) compared with non-cardiogenic shock group. Furthermore, patients with cardiogenic shock had a higher prevalence of pre-procedural thrombolysis in myocardial infarction flow 0-1 (P = 0.05) and associated other vessel chronic total occlusion (P = 0.05) compared with non-cardiogenic shock group. Procedural success rate was lower in the cardiogenic shock compared with non-cardiogenic shock group (77.3 vs. 100%, P = 0.09), whereas in-hospital mortality rate was significantly higher in the cardiogenic shock compared with non-cardiogenic shock group (36.4 vs. 0%, P = 0.02). No deaths were reported among survivors of the acute phase at mid-term follow-up, whereas target lesion revascularization rate was 7.6%. CONCLUSIONS PPCI for ULM-related STEMI in a hospital without on-site surgical back-up was technically feasible in most of the cases. Although the procedural success and in-hospital mortality rates were influenced by cardiogenic shock at admission, an excellent mid-term outcome among patients who survived the hospitalization was reported independently by the severity of clinical presentation.
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Affiliation(s)
- Alfonso Ielasi
- Department of Cardiology, Azienda Ospedaliera 'Bolognini', Seriate (BG), Italy *Drs Ielasi and Silvestro contributed equally to the manuscript and are joint first authors
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15
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Sung PH, Wu CJ, Yip HK. Is Extracorporeal Membrane Oxygenator a New Weapon to Improve Prognosis in Patients With Profound Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention? Circ J 2016; 80:572-8. [PMID: 26853720 DOI: 10.1253/circj.cj-15-1398] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Despite advancements in pharmacological therapy and refinement of the tools and technique of primary percutaneous coronary intervention (PCI) and coronary artery bypass surgery, patients with acute myocardial infarction (AMI) complicated by profound cardiogenic shock (CS) still have unacceptably high in-hospital mortality and unfavorable long-term outcome. Thus, there is an imminent need of a new and safe treatment modality in the management of AMI complicated by profound CS. Growing evidence suggests that extracorporeal membrane oxygenator (ECMO)-supported primary PCI is an effective therapeutic option for saving lives under such conditions. In this review, we describe and interpret the potential role of circulatory mechanical support by ECMO in the setting of AMI complicated by profound CS for improving clinical outcomes. (Circ J 2016; 80: 572-578).
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Affiliation(s)
- Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
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16
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Hashimoto S, Shiraishi J, Nakamura T, Nishikawa M, Yanagiuchi T, Ito D, Kimura M, Kishita E, Nakagawa Y, Hyogo M, Shima T, Sawada T, Matoba S, Yamada H, Matsumuro A, Shirayama T, Kitamura M, Kohno Y, Furukawa K. Survivors of acute myocardial infarction at left main trunk undergoing primary percutaneous coronary intervention. Cardiovasc Interv Ther 2015; 31:89-95. [DOI: 10.1007/s12928-015-0352-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/20/2015] [Indexed: 11/29/2022]
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Staudacher DL, Langner O, Biever P, Benk C, Zehender M, Bode C, Wengenmayer T. Unprotected left main percutaneous coronary intervention in acute coronary syndromes with extracorporeal life support backup. SCIENTIFICA 2015; 2015:435878. [PMID: 25810950 PMCID: PMC4355596 DOI: 10.1155/2015/435878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/09/2015] [Indexed: 06/04/2023]
Abstract
Background. Left main PCI is superior to coronary bypass surgery in selected patients. Registry data, however, suggest significant early adverse event rates associated with unprotected left main PCI. We aimed to evaluate safety of an extracorporeal life support (ECLS) as backup system during PCI. Methods. We report a registry study of 16 high-risk patients presenting with acute coronary syndromes undergoing unprotected left main PCI with an ECLS backup. Results. Seven patients (43.8%) presented with an acute myocardial infarction while 9 patients (56.3%) had unstable angina. Unprotected left main PCI could be successfully performed in all 16 patients. Mortality or thromboembolic event rates were zero within the index hospital stay. General anesthesia was necessary only in 5 patients (31.3%). Access site bleeding requiring transfusion was encountered in 4 patients (25.0%). Three patients (18.8%) developed access site complications requiring surgical intervention. All patients were ECLS-free after 96 hours. Conclusions. Unprotected left main PCI could be safely and effectively performed after ECLS implantation as backup in acute coronary syndromes in our patient collectively. Vascular access site complications however need to be considered when applying ECLS as backup system.
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Affiliation(s)
- Dawid L. Staudacher
- Department of Cardiology and Angiology, Heart Center Freiburg University, Hugstetterstrasse 55, 79106 Freiburg im Breisgau, Germany
| | - Oliver Langner
- Department of Cardiology and Angiology, Heart Center Freiburg University, Hugstetterstrasse 55, 79106 Freiburg im Breisgau, Germany
| | - Paul Biever
- Department of Cardiology and Angiology, Heart Center Freiburg University, Hugstetterstrasse 55, 79106 Freiburg im Breisgau, Germany
| | - Christoph Benk
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Hugstetterstrasse 55, 79106 Freiburg im Breisgau, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology, Heart Center Freiburg University, Hugstetterstrasse 55, 79106 Freiburg im Breisgau, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology, Heart Center Freiburg University, Hugstetterstrasse 55, 79106 Freiburg im Breisgau, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology, Heart Center Freiburg University, Hugstetterstrasse 55, 79106 Freiburg im Breisgau, Germany
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Lee MS, Dahodwala MQ. Percutaneous coronary intervention for acute myocardial infarction due to unprotected left main coronary artery occlusion. Catheter Cardiovasc Interv 2014; 85:416-20. [DOI: 10.1002/ccd.25704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/10/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Michael S. Lee
- Division of Cardiology, UCLA Medical Center; Los Angeles California
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Alozie A, Kische S, Birken T, Kaminski A, Westphal B, Nöldge-Schomburg G, Ince H, Steinhoff G. Awake Extracorporeal Membrane Oxygenation (ECMO) as Bridge to Recovery After Left Main Coronary Artery Occlusion: A Promising Concept of Haemodynamic Support in Cardiogenic Shock. Heart Lung Circ 2014; 23:e217-21. [DOI: 10.1016/j.hlc.2014.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/28/2014] [Accepted: 06/10/2014] [Indexed: 11/28/2022]
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20
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Nikus KC. Electrocardiographic presentations of acute total occlusion of the left main coronary artery. J Electrocardiol 2012; 45:491-3. [DOI: 10.1016/j.jelectrocard.2012.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Indexed: 12/25/2022]
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21
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Hillegass WB. Implicit rationing of percutaneous coronary intervention: the left main test case. Catheter Cardiovasc Interv 2012; 79:1117. [PMID: 22674763 DOI: 10.1002/ccd.24465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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