Clinical outcomes after percutaneous or surgical revascularisation of unprotected left main coronary artery-related acute myocardial infarction: a single-centre experience
- Maik J Grundeken1,
- M Marije Vis1,
- Marcel A M Beijk1,
- Wouter J Kikkert1,
- Peter Damman1,
- Jaap J Kloek2,
- Jan Baan Jr1,
- Karel T Koch1,
- Joanna J Wykrzykowska1,
- Jan G P Tijssen1,
- Bas A J M de Mol2,
- Jose P S Henriques1,
- Jan J Piek1,
- Robbert J de Winter1
- 1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- 2Department of Cardiothoracic surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Correspondence to Professor Robbert J de Winter, Department of Cardiology, Cardiac Catheterization Laboratory B2-137, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands;
- Received 20 November 2012
- Accepted 6 March 2013
- Published Online First 28 March 2013
Objectives We evaluated 30-day and 1-year clinical outcomes after percutaneous or surgical coronary revascularisation in patients with unprotected left main coronary artery (ULMCA)-related acute myocardial infarction (AMI).
Design Single-centre registry.
Patients Between January 1998 and December 2008, 84 patients with ULMCA-related AMI underwent revascularisation treatment in our institution (55 underwent percutaneous coronary intervention (PCI), 29 underwent coronary artery bypass graft surgery (CABG)).
Methods One-year clinical follow-up was obtained for all patients. Univariable and multivariable analyses were performed to find predictors for 30-day mortality and treatment allocation.
Results In the PCI-group, all-cause mortality was 64% at 30 days and 69% at 1 year. In the CABG-group, this was 24% at 30 days and 1 year. Independent predictors of 30-day mortality were cardiogenic shock (HR 2.83), thrombolysis in MI (TIMI) 0/1 flow (HR 2.27) and diabetes mellitus (HR 2.65). Treatment allocation to PCI was primarily determined by TIMI 0/1 flow on baseline angiogram (OR 150). In patients with TIMI 2/3 flow on initial angiogram, treatment allocation was determined by presentation with cardiogenic shock (OR 5.61), year of inclusion (OR 1.72), and distal/bifurcation disease (OR 0.11).
Conclusions Thirty-day mortality was high in patients presenting with an ULMCA-related AMI, both in the PCI as in the CABG-treatment group. Presentation with cardiogenic shock, TIMI 0/1 flow on initial angiogram and diabetes mellitus were independently predicting of 30-day mortality, whereas treatment allocation was primarily determined by presentation with TIMI 0/1 flow.