The presence of acute coronary syndrome, which led to the need for emergency percutaneous coronary intervention of the left main (LM ePCI) coronary artery, was linked to a significant increase in the risk of death. For a study, researchers sought to conduct a multicenter, retrospective, observational cohort study of patients requiring LM ePCI between 2011 and 2018 and reported coronary architecture, treatment modalities, results, and mortality factors. There were a total of 116 consecutive cases included. Patients were predominantly male (85%). The median age of the patients was 68.0 years; 12 patients (10%) had undergone coronary artery bypass grafting previously. ST-elevation was observed in 76 (66%) individuals; 30 (26%) presented with out-of-hospital cardiac arrest (OOHCA) and 47 (41%) with cardiogenic shock. The most prevalent illness pattern was Medina 1,1,1, seen in 59 individuals (51%). The most common approach for revascularization was provisional stenting (95 cases, 82%), with enhanced or thrombolysis in myocardial infarction 3 flow observed in 85 cases (73%). The all-cause death rate was 35% at 30 days and increased to 58% at 5 years. Cardiogenic shock (P=0.018) and OOHCA (P=0.020) were adverse predictors of 30-day death, but increased flow and thrombolysis in myocardial infarction 3 flow in both the circumflex and left anterior descending arteries was associated with a better prognosis (P=0.028). To summarize, individuals with LM ePCI were a high-risk subpopulation frequently displaying cardiogenic shock and OOHCA. Provisional stenting was the approach that was most often recommended for restoring coronary blood flow, despite the challenging anatomy. Cardiogenic shock, out-of-hospital cardiac arrest, and an inability to recover or augment coronary flow were the root causes of the high 30-day mortality rate.
Source – ajconline.org/article/S0002-9149(22)00517-3/fulltext
