Clinical outcomes following emergent percutaneous coronary intervention for acute total/subtotal occlusion of the left main coronary artery

Naoki Shibata, Norio Umemoto, Akihito Tanaka, Kensuke Takagi, Makoto Iwama, Yusuke Uemura, Yosuke Inoue, Yosuke Negishi, Taiki Ohashi, Miho Tanaka, Ruka Yoshida, Kiyokazu Shimizu, Hiroshi Tashiro, Naoki Yoshioka, Itsuro Morishima, Toshiyuki Noda, Masato Watarai, Hiroshi Asano, Toshikazu Tanaka, Yosuke TatamiYasunobu Takada, Hideki Ishii, Toyoaki Murohara

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Data regarding the clinical features, outcomes and prognostic factors in patients presenting with acute total/subtotal occlusion of the unprotected left main coronary artery (LMCA) remain limited. Methods and Results: From a multi-center registry, 134 patients due to acute total/subtotal occlusion of the unprotected LMCA were reviewed. Emergency room (ER) status classification was defined according to the presence of cardiogenic shock and cardiopulmonary arrest (CPA) in the ER (class 1=no cardiogenic shock; class 2= cardiogenic shock but not CPA; and class 3=CPA). In-hospital mortality and cerebral performance category (CPC) as the endpoints were evaluated. One-half (67/134) of the enrolled patients presented with total occlusion of the unprotected LMCA. Regarding ER status classification, class 1, 2, and 3 were observed in 30.6%, 45.5%, and 23.9% of the patients, respectively. In-hospital mortality occurred in 73 (54.5%) patients; of the remaining patients, 52 (85.3%) could be discharged with a CPC 1 or 2. ER status classification (odds ratio 4.4 [95% confidence interval: 2.33–10.67]; P<0.001) and total occlusion of the unprotected LMCA (odds ratio 8.29 [95% confidence interval 2.93–23.46]; P<0.001) were strong predictors of in-hospital mortality. Conclusions: Acute total/subtotal occlusion involving the unprotected LMCA appeared to be associated with high in-hospital mortality. ER status classification and initial flow in the unprotected LMCA were significant predictive factors of in-hospital mortality.

Original languageEnglish
Pages (from-to)1789-1796
Number of pages8
JournalCirculation Journal
Volume85
Issue number10
DOIs
Publication statusPublished - 24-09-2021
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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