Clinical outcomes after unprotected left main coronary artery occlusion: A retrospective multicentre cohort analysis.

AIMS: Unprotected left main coronary artery (ULMCA) occlusion is a rare and disastrous condition with scarce data on presentation and outcomes. Herein, we report data on patients presenting with acute coronary syndrome due to ULMCA occlusion at four different institutions. METHODS: This is an international multicentre observational study. Baseline characteristics were retro- and prospectively collected. Clinical follow-up was prospective. The primary outcome was in-hospital death. Patients surviving the index hospitalization were compared with nonsurvivors to find predictors of survival. RESULTS: The study population consisted of 55 patients. Eight patients (15%) died in the cath lab, and 23 (42%) died in hospital. Three (6%) deaths were noncardiac and due to major bleeding. Thirty-two (58%) patients survived the index hospitalization and were discharged. These patients were followed for a median of 17.5 months during which three cardiac deaths occurred. Repeat revascularization was performed in 25% (n = 8). Overall mortality at maximum follow-up was 47% (n = 26). The only significant predictor for hospital survival was left ventricular ejection fraction (odds ratio [OR]: 1.10 (per 1 point increase); 95% confidence interval [CI]: 1.02-1.19; p = 0.02). CONCLUSION: ULMCA occlusion carries a high short-term mortality. Patients who survive index hospitalization have similar mortality rates as compared with other st elevation myocardial infarction patients.

Twelve-year trends in unprotected left main coronary artery occlusion: insights from a real-world multicentre study.

AIMS: Acute myocardial infarction (AMI) resulting from unprotected left main coronary artery (LMCA) occlusion and subtotal occlusion is a life-threatening condition. Although AMI management has improved in the past two decades, there is limited information on recent trends in patient characteristics, management, and outcomes for acute unprotected LMCA-related AMI. This study aims to assess such trends over a 12 year period. METHODS AND RESULTS: This retrospective multicentre study includes patients with unprotected LMCA occlusion/subtotal occlusion admitted to three tertiary hospitals between 2008 and 2020. The patients were divided into two groups based on the chronology of presentation: a 'past group' (January 2008 to December 2014) and a 'contemporary group' (January 2015 to December 2020). The study compares clinical characteristics, management approaches, and outcomes between the two groups. The study includes 128 patients, with 51 (40%) in the 'past group' and 77 (60%) in the 'contemporary group'. Baseline risk factors did not show statistically significant differences between the two groups, except for hypertension (49% vs. 74%; P = 0.005). Chest pain was more frequent in the 'past group' (98% vs. 89%; P = 0.014), and a trend towards more cardiac arrests was observed in the 'contemporary group' (18% vs. 31%; P = 0.087). Revascularization type did not differ significantly (P = 0.419), but manual thrombectomy was less frequently used (41% vs. 23%; P = 0.032) and stent implantation showed a trend towards higher rates (66% vs. 78%; P = 0.150) in the 'contemporary cohort'. There was a gradual shift from bare-metal to drug-eluting stents, with a significantly higher percentage of ticagrelor/prasugrel loading in the 'contemporary cohort' (5% vs. 79%; P < 0.001). The use of mechanical circulatory support (MCS), although not statistically significant, was higher among patients in the 'past group' (67% vs. 51%; P = 0.073). The type of MCS differed significantly between groups, with a decrease in intra-aortic balloon pump use (67% vs. 42%; P = 0.005) and an increase in veno-arterial extracorporeal membrane oxygenation (4% vs. 22%; P = 0.005) and Impella system (0% vs. 3%) over time. Survival analysis showed no significant differences (P = 0.599; log-rank test) in all-cause mortality between the different time groups, with the long-term survival rate being approximately 30%. CONCLUSIONS: In our real-world population, despite the progressive use of newer drugs and more advanced devices over time, patients with unprotected LMCA occlusion/subtotal occlusion remain a subpopulation with poor prognosis.

Concomitant complete atrioventricular block and left main coronary artery occlusion during transcatheter aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) is now considered a viable alternative therapy to surgery in patients with severe symptomatic aortic stenosis, considered to have a high risk for surgery. Herein, we present a case of severe aortic stenosis treated with transfemoral aortic valve implantation and complicated by complete atrioventrciular block and left main coronary artery obstruction that was successfully managed with permanent pacemaker implantation and left main coronary artery stenting. Although less invasive, TAVI can be associated with major complications. Therefore, extra care is required when performing TAVI in patients with borderline valve to coronary ostia distance.

Under-deployed TAVI with occluded left-main and severe aortic regurgitation; bailout chimney-in-chimney stenting and aggressive postdilatation saves the day.

Narrow calcific aortic roots with low coronary heights present challenges for a successful trans-catheter aortic valve replacement. We describe a case where pre-emptive coronary protection and chimney stent-in-stent procedure was successfully performed during a cardiac arrest secondary to coronary occlusion and restricted TAVI valve deployment in such an anatomy.

Successful Management of an Iatrogenic Left Main Coronary Artery Occlusion during Coronary Angiography: A Case Report and Brief Review.

Abrupt left main coronary artery (LMCA) closure during diagnostic coronary angiography is a rare but catastrophic event with a poor prognosis. Emergency reperfusion of the LMCA with hemodynamic support should be the primary goal in patients with acute LMCA occlusion. Emergency coronary artery bypass graft surgery may be effective but time-consuming, and carries the risk of extensive and irreversible myocardial damage. We describe a case of abrupt closure of the LMCA due to plaque rupture by a diagnostic angiographic catheter without visible dissection following coronary angiography that was successfully treated with bail-out stenting during cardiopulmonary resuscitation.

A case of double stent implantation for left main coronary artery occlusion in transcatheter aortic valve implantation using SAPIEN XT device.

Transcatheter aortic valve implantation is an established alternative and less invasive procedure to replace heart valves in symptomatic aortic stenosis patients; however, severe, life-threatening complications still exist. Coronary artery occlusion is a primary complication. We report a case of left main coronary artery occlusion after transcatheter aortic valve replacement, which was ameliorated using a double stent implantation technique.

Acute total occlusion of the left main coronary artery treated with percutaneous intervention and simultaneous implantation of intra-aortic balloon pump.

Electrocardiographic findings at first medical contact and direct transfer to the catheterization laboratory are important in acute total occlusion of the left main coronary artery. Simultaneous emergency angioplasty and intra-aortic balloon pump implantation might be beneficial in overcoming the patient's most critical hemodynamic instability.

The clinical application of a new interventional therapy for acute left main coronary artery occlusion / 介入放射学杂志

Objective To investigate the curative effect of a new interventional therapy for acute left main coronary artery occlusion.Methods The clinical data of a total of 58 patients with acute left main coronary artery occlusion,who were admitted to authors' hospital during the period from May 2003 to October 2016 to receive treatment,were retrospectively analyzed.Among the 58 patients,14 patients underwent traditional percutaneous coronary intervention (PCI group),and 44 patients (combination treatment group) received small balloon expansion first,and subsequent stent implantation was carried out in 30-40 min after the coronary blood flow restored to grade Ⅲ of TIMI classification.Results In PCI group,8 patients died,the mortality was 57.1％(8/14).In combination treatment group,only 3 patients died,the mortality was 6.8％ (3/44).Conclusion For the treatment of acute left main coronary artery occlusion,combination use of small balloon expansion and subsequent stent implantation is a safe and effective therapy with lower mortality.

Primary PCI for acute myocardial infarction caused by acute left main coronary artery occlusion / 中国实用内科杂志

Objective To study mortality of acute myocardial infarction caused by acute left main coronary artery occlusion.The objectives of this analysis were to determine the effect of primary PCI and the impact of cardiogenic shock on acute myocardial infarction caused by acute left main coronary artery occlusion.Methods From 1999 to 2005,of 752 consecutive patients with acute myocardial infarction,16 patients had acute left main coronary artery occlusion with TIMI flow≤2.All patients were given primary PCI.Results Of these 16 patients,9(56.25%)died in hospital,and 7(43.75%)discharged.In the survival group reperfusion was successful in 100% of patients,as opposed to 44.44% in the mortality group(P=0.019).Cardiogenic shock was overt in 12(75.00%)patients,42.86% of the survival group and 100% of the mortality group(P=0.020).Shock patients had higher in-hospital mortality than stable patients(75 % vs 0%,odds=4.0,95%CI 1.50~10.66,P=0.019).Conclusion Patients presenting with AMI caused by acute left main coronary artery occlusion and cardiogenic shock have poor survival regardless of primary PCI.Nevertheless,primary PCI is a feasible and effective procedure,and it may save lives in this clinical setting.