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Outcomes of primary percutaneous coronary intervention in acute myocardial infarction due to unprotected left main thrombosis: The Asia-Pacific Left Main ST-Elevation Registry (ASTER).

Authors
 Jonathan Yap  ;  Gagan D. Singh  ;  Jung‐Sun Kim  ;  Krishan Soni  ;  Kelvin Chua  ;  Alvin Neo  ;  Choong Hou Koh  ;  Ehrin J. Armstrong  ;  Stephen W. Waldo  ;  Kendrick A. Shunk  ;  Reginald I. Low  ;  Myeong‐Ki Hong  ;  Yangsoo Jang  ;  Khung Keong Yeo 
Citation
 JOURNAL OF INTERVENTIONAL CARDIOLOGY, Vol.31(2) : 129-135, 2018 
Journal Title
 JOURNAL OF INTERVENTIONAL CARDIOLOGY 
ISSN
 0896-4327 
Issue Date
2018
MeSH
Aged ; Coronary Artery Bypass/statistics & numerical data ; Coronary Vessels*/pathology ; Coronary Vessels*/surgery ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Percutaneous Coronary Intervention*/adverse effects ; Percutaneous Coronary Intervention*/methods ; Registries/statistics & numerical data ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; ST Elevation Myocardial Infarction*/diagnosis ; ST Elevation Myocardial Infarction*/mortality ; ST Elevation Myocardial Infarction*/surgery ; Singapore/epidemiology ; Treatment Outcome ; United States/epidemiology
Keywords
acute coronary syndromes ; complex coronary interventions ; mortality
Abstract
INTRODUCTION: Prior studies of ULM STEMI have been confined to small cohorts. Recent registry data with larger patient cohorts have shown contrasting results. We aim to study the outcomes of patients with unprotected left main (ULM) ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). METHODS: The Asia-pacific left main ST-Elevation Registry (ASTER) is a multicenter retrospective registry involving 4 sites in Singapore, South Korea, and the United States. The registry included patients presenting with STEMI due to an ULM coronary artery culprit lesion who underwent emergency PCI. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events. RESULTS: A total of 67 patients (mean age 64.2 ± 12.8 years, 53 [79.1%] males) were included. The distal left main bifurcation was most commonly involved (85%, n = 57). Fifty one (76%) patients had TIMI 3 flow post-PCI. The in-hospital mortality rate was 47.8% (n = 32); 61% (n = 41) had cardiac failure, 4% (n = 3) had emergency coronary artery bypass grafting, 1% (n = 1) had a re-infarction, 3% (n = 2) had stroke and 55% (n = 37) had malignant ventricular arrhythmias. On multivariate analysis, predictors of in-hospital mortality included older age (odds ratio (OR) 1.085 (95% confidence interval (CI) 1.002-1.175), P = 0.044), diabetes mellitus (OR 10.882 (95%CI 11.074-110.287), P = 0.043) and absence of post-PCI TIMI 3 flow (OR 71.429 (95%CI 2.985-1000), P = 0.008). CONCLUSIONS: STEMI from culprit unprotected left main coronary artery stenosis is associated with significant mortality and morbidity. Emergency PCI provides an important treatment option in this high-risk group, but in-hospital mortality remains high.
Full Text
https://onlinelibrary.wiley.com/doi/full/10.1111/joic.12466
DOI
10.1111/joic.12466
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/165838
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