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Outcomes of patients with acute unprotected left main coronary occlusion: a multicentre study
Session:
Posters (Sessão 2 - Écran 1) - DAC e Cuidados Intensivos 2 - Tronco comum e Idade
Speaker:
Marta Braga
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Marta Braga; Joao Calvao; João Carlos Silva; Mariana Brandão; Marisa Passos Silva; Gustavo Pires Morais; André Alexandre; Andreia Campinas; Bruno Brochado; Filipe Macedo
Abstract
<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Background and purpose:</span></strong><span style="font-size:12.0pt"> Acute myocardial infarction (MI) due to left main coronary artery (LMCA) occlusion is a rare event and limited data are available on morbidity and mortality of these patients. This study sought to evaluate short- and long-term outcomes of patients with acute MI (≤12h of symptom onset) due to unprotected LMCA occlusion. </span></span></span></p> <p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Methods:</span></strong><span style="font-size:12.0pt"> We performed a retrospective multicentre analysis of 128 consecutive patients presented with ST-segment elevation MI (STEMI) or very high-risk non-ST segment elevation MI from January 2008 to December 2020, whose emergent coronary angiography showed acute unprotected left main coronary artery occlusion/subocclusion (Thrombolysis In Myocardial Infarction – TIMI ≤2). </span></span></span></p> <p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Results: </span></strong><span style="font-size:12.0pt">Mean age was 63.3</span><span style="font-size:12.0pt">±11.4 years and 74.2% were male. Only 12.5% of patients had previous MI. Chest pain was the most frequent symptom referred, whereas syncope was described in 10.2% of patients. Most patients presented with STEMI and 50.8% had V1-V4 ST elevation on electrocardiography. Emergent coronary angiography showed distal LMCA occlusion in 71 (55.5%) patients, 59 (46.1%) had TIMI 0 and 88 (68.8%) had Rentrop grade 0. Primary percutaneous coronary intervention (PCI) was performed in 110 (85.9%) patients and was successful (remaining stenosis<30% and TIMI=3) in 71.8%. Severe left ventricle systolic dysfunction (LVSD) was reported in 32.3% and only 10 patents (7.8%) had moderate to severe mitral valve regurgitation. Only 1 mechanical myocardial complication was described. About 74.2% of patients complicated with cardiogenic shock (CS) at admission or during hospitalization, 52.3% needed mechanical invasive ventilation and 10.9% required haemodialysis. Mechanical circulatory support (MCS) was used in 69 (53.9%) patients, mostly intra-aortic balloon pump. Extracorporeal membrane oxygenation was used in 19 (14.8%) patients. In-hospital mortality was 51.6%. Severe LVSD and CS were independent predictors of in-hospital mortality (odds ratio [OR]: 63.4 [95% confidence interval (CI): 6.0 to 669.7], p=0.001, and OR 10.5 [95% CI: 1.4 to 77.6], p=0.021, respectively). After a median follow-up of 32.0 months (P<sub>25</sub> 12.8, P<sub>75</sub> 75.0), 38.7% of in-hospital survivors had died and 30 (48.4%) patients experienced major adverse cardiac events, defined as death, acute MI, repeated LM PCI, or heart failure hospitalization. </span></span></span></p> <p><strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Conclusions: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Acute MI due to unprotected LMCA occlusion is associated with high in-hospital mortality, especially if patients presented with CS and/or severe LVSD. Survivors of index MI have also poor long-term outcomes. This study highlights the need to further trials in this high-risk subgroup to optimize treatment strategy and improve their outcomes.</span></span></p>
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