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Emergency percutaneous coronary intervention in unprotected left main coronary arteries. Predictors of mortality and impact of cardiogenic shock.
Hurtado, José; Pinar Bermúdez, Eduardo; Redondo, Belén; Lacunza Ruiz, Javier; Gimeno Blanes, Juan Ramón; García de Lara, Juan; Valdesuso Aguilar, Raúl; Teruel, Francisca; Valdés Chavarri, Mariano.
Afiliación
  • Hurtado J; Servicio de Cardiología, Sección de Hemodinámica, Hospital Virgen de la Arrixaca, Murcia, España. josehurtadomartinez@yahoo.es
Rev Esp Cardiol ; 62(10): 1118-24, 2009 Oct.
Article en En, Es | MEDLINE | ID: mdl-19793517
INTRODUCTION AND OBJECTIVES: Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) disease may be essential following acute myocardial infarction (AMI). However, few data are available on the use of emergency PCI in unprotected LMCAs outside of clinical trials. The objective of this study was to determine the frequency of in-hospital mortality, its predictors and its association with cardiogenic shock, and long-term outcomes in patients with unprotected LMCA disease who undergo emergency PCI because of AMI. METHODS: The study included 71 consecutive patients who underwent emergency angioplasty of the LMCA and who were followed up clinically. RESULTS: Overall, 42 patients (59%) had ST-elevation AMI and 47 (66%) had cardiogenic shock or developed it during PCI. Eleven patients (16%) died in the catheterization laboratory and 33 (47%) died during hospitalization. Inhospital mortality was similar in those with and without evidence of ST-segment elevation on ECG (48% vs. 45%; P=1). Multivariate analysis showed that the predictors of in-hospital mortality were cardiogenic shock (odds ratio [OR]=4.5; 95% confidence interval [CI], 1.1-18) and incomplete revascularization (OR=5.1; 95% CI, 1.0-26). After discharge, 39 patients were followed up for a median of 32 months. Mortality in the first year was 10%. CONCLUSIONS: Emergency PCI is a viable therapeutic option for AMI due to unprotected LMCA disease. However, in-hospital mortality is high, regardless of ST-segment elevation, particularly if there is cardiogenic shock or complete revascularization has not been achieved.
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Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Angioplastia Coronaria con Balón Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male Idioma: En / Es Revista: Rev Esp Cardiol Año: 2009 Tipo del documento: Article
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Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Angioplastia Coronaria con Balón Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male Idioma: En / Es Revista: Rev Esp Cardiol Año: 2009 Tipo del documento: Article