TY - JOUR
T1 - Clinical outcomes following emergent percutaneous coronary intervention for acute total/subtotal occlusion of the left main coronary artery
AU - Shibata, Naoki
AU - Umemoto, Norio
AU - Tanaka, Akihito
AU - Takagi, Kensuke
AU - Iwama, Makoto
AU - Uemura, Yusuke
AU - Inoue, Yosuke
AU - Negishi, Yosuke
AU - Ohashi, Taiki
AU - Tanaka, Miho
AU - Yoshida, Ruka
AU - Shimizu, Kiyokazu
AU - Tashiro, Hiroshi
AU - Yoshioka, Naoki
AU - Morishima, Itsuro
AU - Noda, Toshiyuki
AU - Watarai, Masato
AU - Asano, Hiroshi
AU - Tanaka, Toshikazu
AU - Tatami, Yosuke
AU - Takada, Yasunobu
AU - Ishii, Hideki
AU - Murohara, Toyoaki
N1 - Publisher Copyright:
© 2021 Japanese Circulation Society. All rights reserved.
PY - 2021/9/24
Y1 - 2021/9/24
N2 - 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.
AB - 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.
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U2 - 10.1253/circj.CJ-20-0545
DO - 10.1253/circj.CJ-20-0545
M3 - Article
C2 - 33746154
AN - SCOPUS:85115412956
SN - 1346-9843
VL - 85
SP - 1789
EP - 1796
JO - Circulation Journal
JF - Circulation Journal
IS - 10
ER -