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Title: | Primary percutaneous coronary intervention for acute myocardial infarction caused by unprotected left main stem thrombosis. | Authors: | Malaiapan Y.;MacIsaac A.;Meredith I.T. ;Ahmar W.;Prasad S.B.;Whitbourn R. | Institution: | (Prasad, Malaiapan, Ahmar, Meredith) MonashHeart, Monash Medical Centre, 246 Clayton Road, Melbourne, VIC 3168, Australia (Whitbourn, MacIsaac) St Vincents' Hospital, Victoria Parade, Melbourne, VIC, Australia | Issue Date: | 14-Oct-2012 | Copyright year: | 2009 | Publisher: | Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States) | Place of publication: | United States | Publication information: | Catheterization and Cardiovascular Interventions. 73 (3) (pp 301-307), 2009. Date of Publication: 15 Feb 2009. | Abstract: | Background: There is a paucity of data on outcomes in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) caused by left main stem (LMS) thrombosis. Objective(s): We sought to determine (i) the clinical features, (ii) correlates of early mortality, and (iii) long-term outcomes in contemporary patients undergoing primary PCI for unprotected LMS thrombosis. Method(s): From 1,115 consecutive primary PCI cases at two tertiary referral centers between January 2004 and September 2007, 28 cases (2.5%) with unprotected LMS culprit lesions were identified. Data were obtained from review of institutional databases, folder audit, telephone survey of patients, and independent review of angiograms. Result(s): The mean age of patients was 68 +/- 14 years. Males comprised 76%, and 21% had diabetes. Significant morbidity was noted at presentation: shock in 18 (62%), pulmonary oedema in 15 (52%), and cardiac arrest in 10 (35%) patients, respectively. Lesion location was ostial in 7 (25%), body in 8 (29%), and distal in 13 (46%) patients, respectively. Angiographic success was achieved in 24 patients (83%). Stents were deployed in 27 patients (96%); drug-eluting stents in 11 patients (39%). No patient required in-hospital CABG. Cumulative in-hospital mortality was 36%. Univariate predictors of in-hospital mortality included shock, preceding cardiac arrest, and angiographic failure (all P < 0.05). At a mean follow-up of 26 +/- 12 months in hospital survivors, there were two TVR (elective CABGs), one death, and no reinfarctions. Conclusion(s): We report a lower than previously reported in-hospital mortality of 36% in contemporary patients undergoing primary PCI for unprotected LMS thrombosis. Long-term outcomes in hospital survivors appear favorable. © 2009 Wiley-Liss, Inc. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1002/ccd.21886 | PubMed URL: | 19213083 [http://www.ncbi.nlm.nih.gov/pubmed/?term=19213083] | ISSN: | 1522-1946 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/31205 | Type: | Article |
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