Author + information
- Jesus Piqueras-Flores1,
- Ignacio Sanchez-Perez1,
- Fernando Lozano1,
- María Thiscal López Lluva1,
- Natalia Pinilla-Echeverri2,
- Ramón Maseda Uriza1,
- Manuel Marina-Breysse1 and
- Alfonso Jurado-Román1
Left main coronary artery (LMCA) acute occlusion is uncommon (0.8% of primary percutaneous coronary interventions -PCI-) with very poor prognosis. In this situation, primary PCI is a complex procedure because of hemodynamic and electrical instability of patients with a high mortality. The main objective of this study was to evaluate the efficacy and safety of primary PCI in LMCA disease at a 10-year clinical follow-up.
We prospectively included 33 consecutive patients (67.6 ± 11.7 years, 78.8% male) with STEMI undergoing primary PCI in LMCA between June 2006 and April 2016. We evaluated the presence of major cardiac events (MACE) defined as cardiac death, nonfatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after a 10-year clinical follow-up (median 45.5 months).
Door-to-balloon mean time was 25 minutes and system delay mean time was 165.23 minutes. 21,2% were diabetic patients and 48% had Killip class 3-4 at presentation. An intra-aortic balloon pump was needed in 33.3%. 93.9% were LMCA bifurcation lesions. We performed thromboaspiration in the 46.7% of cases and abciximab was used in the 33.4% of patients. The most frequent technique employed was “provisional stenting” in 87.5% of cases and zotarolimus eluting stent was implanted in 77.4% of patients. Final “kissing-balloon” was performed in the 46.9% of the patients. There was one stroke post PCI. During follow-up, MACE rate at 10 years was 34.5%. We observed a cardiac death rate of 24.2% (in-hospital mortality 21.2%), non-fatal acute myocardial infarct rate of 3.3%, TLR rate of 3.3% and 0% of stent thrombosis rate. The MACE rate was significantly higher in patients with moderate-severe left ventricular systolic dysfunction (p=0.007) and patients with Killip class 3-4 at presentation (p=0.004). 24.2% of patients had an angiographic follow-up.
In spite of high angiographic success rate without complications at the procedure, primary PCI in LMCA disease presents high in-hospital mortality. Those patients who get to be discharged from the hospital have very favourable results with a low rate of mayor cardiac events at very long-term follow-up.
CORONARY: Acute Myocardial Infarction