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Emergency percutaneous coronary intervention in left main coronary artery

Session Poster Session 2

Speaker Ines Silveira

Event : Acute Cardiovascular Care 2016

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Interventional Cardiology
  • Session type : Poster Session

Authors : I Silveira (Porto,PT), R B Santos (Porto,PT), M Trepa (Porto,PT), B Brochado (Porto,PT), A Luz (Porto,PT), J Silveira (Porto,PT), H Carvalho (Porto,PT), S Torres (Porto,PT)

I Silveira1 , R B Santos1 , M Trepa1 , B Brochado1 , A Luz1 , J Silveira1 , H Carvalho1 , S Torres1 , 1Hospital Center of Porto, Cardiology - Porto - Portugal ,

European Heart Journal Supplement ( 2010 ) 12 ( Supplement F ), F142

Introduction: Current guidelines recommend emergent invasive study in all patients with ST elevated acute myocardial infarction (STEMI) or non ST acute coronary syndrome (NST-ACS) with hemodynamic instability. Even uncommon, left main could be involved and management of these patients, specially, in hospitals without cardiac surgery could be difficult and related to a poor prognosis.
Methods: Retrospective study of 81 consecutive patients, who underwent percutaneous coronary intervention to a left main coronary artery (LM PCI), in our center, from June 2008 to June 2015. From those, we selected the patients submitted to an emergency LM PCI in context of an acute coronary syndrome (STEMI or NST-ACS with hemodynamic instability).
Results: Overall, 18 patients required emergency LM PCI. Mean age was 63.5±12.2 years old, with 58.8% of men. 41.5% of the patients presented with STEMI and 47.1% in cardiogenic shock. Mean Syntax score was 35.7±16.9. The majority of patients had an unprotected left main (82.4%) and a distal lesion was found in 42.2%. Three vessel disease was present in 47.1% of the patients and a total occluded LM artery was described in 35.3% of cases. Intra-aortic ballon insertion was used in 29.4%. The in-hospital mortality rate was 35.3%, with no significant differences in patients with or without evidence of ST-segment elevation on ECG (42.9% vs 30.0%; p=0.484). At discharge moderate to severe left ventricular dysfunction was present in 72.7% of the patients. At one year follow-up, in hospital survivors had a mortality rate of 5.9%.
Conclusion: Patients requiring emergency LM PCI are a high risk subgroup, with a substantial mortality particularly in acute phase. LM PCI is a viable therapeutic option, special in non-surgical hospitals when transferring an unstable patient is challenging. In hospital survivors had a satisfactory one year outcome.

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