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Skorupski WJ, Kałużna-Oleksy M, Mitkowski P, Araszkiewicz A, Skorupski W, Grajek S, Pyda M, Lesiak M, Grygier M. The impact of left circumflex coronary artery ostium stenosis on outcomes for patients after percutaneous coronary intervention for unprotected left main disease. Kardiol Pol 2023; 81:903-908. [PMID: 37489824 DOI: 10.33963/kp.a2023.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The impact of left circumflex coronary artery (LCX) ostium atherosclerosis in left main coronary artery (LM) bifurcation disease is not well-known. AIM The study aimed to assess whether the involvement of LCX ostium carries prognostic implications in patients undergoing unprotected LM percutaneous coronary intervention (PCI). METHODS Consecutive 564 patients with unprotected LM (ULMCA) disease who underwent LM PCI between January 2015 and February 2021, with at least 1 year of available follow-up were included in the study. The first group was composed of 145 patients with ULMCA disease with LCX ostium stenosis, and the second group consisted of 419 patients with ULMCA disease without LCX ostium stenosis. RESULTS Patients in the group with ULMCA disease with LCX ostium stenosis were significantly older and had more comorbidities. The two-stent technique was used more often in the group with LCX ostium stenosis (62.8% vs. 14.6%; P <0.001). During 7-year follow-up, all-cause mortality did not differ significantly between groups with and without LCX ostium stenosis (P = 0.50). The use of one-stent or two-stent technique also did not impact mortality in patients with LCX ostial lesions (P = 0.75). Long-term mortality subanalysis for three groups of patients: (1) patients with LM plus LCX ostium stenosis; (2) LM plus left anterior descending artery (LAD) ostium stenosis; (3) LM plus LCX ostium plus LAD ostium stenosis also did not differ significantly (P = 0.63). CONCLUSIONS LCX ostium involvement in LM disease PCI is not associated with adverse long-term outcomes, which is highly beneficial for the Heart Team's decision-making process.
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Affiliation(s)
- Wojciech Jan Skorupski
- Chair and 1st Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland.
| | - Marta Kałużna-Oleksy
- Chair and 1st Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Przemysław Mitkowski
- Chair and 1st Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Aleksander Araszkiewicz
- Chair and 1st Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Włodzimierz Skorupski
- Chair and 1st Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Stefan Grajek
- Chair and 1st Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Małgorzata Pyda
- Chair and 1st Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Maciej Lesiak
- Chair and 1st Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Marek Grygier
- Chair and 1st Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland
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Pereira AR, Calé R, Briosa A, Santos JG, Sebaiti D, Martinho M, Ferreira B, Marques A, Alegria S, Gomes AC, Morgado G, Martins AC, Pereira H. Percutaneous versus surgical revascularization of unprotected left main coronary artery: Data from the Portuguese Registry of Acute Coronary Syndromes (ProACS). Rev Port Cardiol 2023:S0870-2551(23)00171-3. [PMID: 36958582 DOI: 10.1016/j.repc.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 07/28/2022] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND In acute coronary syndromes (ACS), the optimal revascularization strategy for unprotected left main coronary artery (ULMCA) culprit lesion has been under-investigated. Therefore, we compared clinical characteristics and short- and medium-term outcomes of percutaneous and surgical revascularization in ACS. METHODS AND RESULTS Of 31 886 patients enrolled in a multicenter, national, prospective registry study between October 2010 and December 2020, 246 (0.8%) had ULMCA as a culprit lesion and underwent percutaneous coronary intervention (PCI) alone (n=133, 54%) or coronary artery bypass grafting (CABG) alone (n=113, 46%). Patients undergoing PCI presented more frequently ongoing chest pain (68% versus 41%, p<0.001) and cardiogenic shock (25% versus 1%, p<0.001). Time from admission to revascularization was higher in surgical group with a median time to CABG of 4.5 days compared to 0 days to PCI (p<0.001). Angiographic success rate was 93.2% in patients who underwent PCI. Primary endpoint (all-cause death, non-fatal reinfarction and/or non-fatal stroke during hospitalization) occurred in 15.9% of patients and was more frequent in the PCI group (p<0.001). After adjustment, surgical revascularization was associated with better in-hospital prognosis (odds ratio (OR) 0.164; 95% confidence interval (CI), 0.04-0.64; p=0.009). Similar results were achieved after propensity score matching. No difference was found at one-year all-cause death. CONCLUSION Percutaneous coronary intervention was the most common revascularization strategy in the ACS with ULMCA culprit lesion. PCI was preferred in unstable patients and presented a high angiographic success. CABG was often delayed and preferred in low-risk patients. At one-year follow-up, PCI and CABG conferred a similar prognosis. The two approaches appear complementary in this high risk cohort.
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Affiliation(s)
- Ana Rita Pereira
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
| | - Rita Calé
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Alexandra Briosa
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | | | - Daniel Sebaiti
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Mariana Martinho
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Bárbara Ferreira
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Marques
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Sofia Alegria
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | | | - Gonçalo Morgado
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | | | - Hélder Pereira
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal; Cardiovascular Center of the University of Lisbon, Lisbon, Portugal; Academic Medical Center of Lisbon, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Alasmari A, Iskandar M, Daoulah A, Hersi AS, Alshehri M, Aljohar A, Al Garni T, Abuelatta R, Yousif N, Almahmeed W, Kazim HM, Refaat W, Selim E, Alzahrani B, Alqahtani AH, Ajaz Ghani M, Amin H, Hashmani S, El-Sayed O, Jamjoom A, Hurley WT, Dahdouh Z, Aithal J, Ahmad O, Ramadan M, Ibrahim AM, Elganady A, Qutub MA, Alama MN, Abohasan A, Hassan T, Balghith M, Altnji I, Hussien AF, Abdulhabeeb IAM, Qenawi W, Shawky A, Ghonim AA, Elmahrouk A, Hiremath N, Jameel Naser M, Shawky AM, Lotfi A. One Versus Two Stents Strategies for Unprotected Left Main Intervention: Gulf Left Main Registry. Angiology 2022:33197221121004. [PMID: 35969482 DOI: 10.1177/00033197221121004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The optimal stenting strategy for unprotected left main coronary artery (ULMCA) disease remains debated. This retrospective observational study (Gulf Left Main Registry) analyzed the outcomes of 1 vs 2 stents in patients with unprotected left main percutaneous coronary intervention (PCI). Overall, 1222 patients were evaluated; 173 had 1 stent and 1049 had 2 stents. The 2-stent group was older with more comorbidities, higher mean SYNTAX scores, and more distal bifurcation lesions. In the 1-stent group, in-hospital events were significant for major bleeding, and better mean creatinine clearance. At median follow-up of 20 months, the 1-stent group was more likely to have target lesion revascularization (TLR). Total mortality was numerically lower in the 1-stent group (.00% vs 2.10%); however, this was not statistically significant (P=.068). Our analysis demonstrates the benefits of a 2-stent approach for ULMCA patients with high SYNTAX scores and lesions in both major side branches, while the potential benefit of a 1-stent approach for less complex ULMCA was also observed. Further studies with longer follow-up are needed to definitively demonstrate the optimal approach.
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Affiliation(s)
- Abdulaziz Alasmari
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Mina Iskandar
- Department of Internal Medicine-Pediatrics Residency Program, UMass Chan Medical School, 21645Baystate Medical Center, Springfield, MA, USA
| | - Amin Daoulah
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Ahmad S Hersi
- Department of Cardiac Sciences, 534885King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alshehri
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Alwaleed Aljohar
- Department of Cardiac Sciences, 534885King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Turki Al Garni
- Department of Cardiology, 48077Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Reda Abuelatta
- Department of Cardiology, 363886Madinah Cardiac Center, Madinah, Kingdom of Saudi Arabia
| | - Nooraldaem Yousif
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, 144878Kingdom of Bahrain, Bahrain
| | - Wael Almahmeed
- Heart & Vascular Institute, 284697Cleveland Clinic Abu Dhabi, UAE
| | - Hameedullah M Kazim
- Department of Cardiology, 37842Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Wael Refaat
- Department of Cardiology, 204603Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Ehab Selim
- Department of Cardiology, 37842Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Badr Alzahrani
- Department of Cardiology, 48077Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman H Alqahtani
- Department of Emergency Medicine,48168King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Ajaz Ghani
- Department of Cardiology, 363886Madinah Cardiac Center, Madinah, Kingdom of Saudi Arabia
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, 144878Kingdom of Bahrain, Bahrain
| | | | - Osama El-Sayed
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Jamjoom
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - William T Hurley
- Department of Emergency Medicine, 2569Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Ziad Dahdouh
- Department of Cardiovascular Medicine, 37852King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Jairam Aithal
- Department of Cardiology, Yas Clinic, Khalifa City A, Abu Dhabi, UAE
| | - Osama Ahmad
- Department of Cardiovascular Medicine, 37852King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Ramadan
- Department of Cardiology, 204603Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Ahmed M Ibrahim
- Department of Cardiology, 48051Saudi German Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdelmaksoud Elganady
- Department of Cardiology, 124911Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed A Qutub
- Cardiology Center of Excellence, Department of Medicine, 37848King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mohamed N Alama
- Cardiology Center of Excellence, Department of Medicine, 37848King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdulwali Abohasan
- Department of Cardiology, 557798Prince Sultan Cardiac Center, Qassim, Kingdom of Saudi Arabia
| | - Taher Hassan
- Department of Cardiology, 48131Bugshan General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed Balghith
- King Abdulaziz Cardiac Center, College of Medicine, 48149King Saud Bin Abdulaziz University for Health Science, Riyadh, Kingdom of Saudi Arabia
| | - Issam Altnji
- Department of Cardiology, 58005Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Adnan Fathey Hussien
- Department of Cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Ibrahim A M Abdulhabeeb
- Department of Cardiology, King Abdulaziz Specialist Hospital, Al Jawf, Kingdom of Saudi Arabia
| | - Wael Qenawi
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Ahmed Shawky
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Ahmed A Ghonim
- Cardiology Center of Excellence, Department of Medicine, 37848King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Elmahrouk
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia.,Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | | | - Maryam Jameel Naser
- Department of Internal Medicine, 21645Baystate Medical Center, Springfield, MA, USA
| | - Abeer M Shawky
- Department of Cardiology, 124911Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Amir Lotfi
- Department of Cardiovascular Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
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González-Bravo DH, Escabí-Mendoza J. Electrocardiographic Recognition of Unprotected Left Main ST-Segment Elevation Myocardial Infarction: Looking Beyond aVR. JACC Case Rep 2021; 3:754-759. [PMID: 34317620 PMCID: PMC8311158 DOI: 10.1016/j.jaccas.2021.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
ST-segment elevation in aVR has traditionally been used for electrocardiographic identification of left main coronary artery (LM) myocardial infarction. We present two ST-segment elevation myocardial infarction (STEMI) cases with acute total occlusion of the LM without aVR ST-segment elevation. This report reviews the different electrocardiographic discriminators suggestive of unprotected LM STEMI. (Level of Difficulty: Intermediate.)
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Key Words
- ATO, acute total occlusion
- IABP, intra-aortic balloon pump
- LAD, left anterior descending coronary artery
- LADEV, left axis deviation
- LAFB, left anterior fascicular block
- LM, left main coronary artery
- NPV, negative predictive value
- PCI, percutaneous coronary intervention
- PPV, positive predictive value
- RBBB, right bundle branch block
- STD, ST-segment depression
- STE, ST-segment elevation
- STEMI
- STEMI, ST-segment elevation myocardial infarction
- TIMI, Thrombolysis In Myocardial Infarction
- acute myocardial infarction
- electrocardiogram
- unprotected left main coronary artery
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Affiliation(s)
| | - José Escabí-Mendoza
- Address for correspondence: Dr. José Escabí-Mendoza, Director of the Accredited Chest Pain Center and the Cardiac Intensive Care Unit, Veterans Affairs Caribbean Healthcare System, Puerto Rico and U.S. Virgin Islands, 10 Casia Street, San Juan 00921, Puerto Rico.
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5
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Yarusi BB, Jagadeesan VS, Jivan A, Unger ED, Van Assche LMR, Provias TS, Flaherty JD, Benzuly KH, Schimmel DR. The Utility of Peripheral Intravascular Lithotripsy in Calcific Coronary Artery Disease: A Case Series. J Invasive Cardiol 2021; 33:E245-E251. [PMID: 33723088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Coronary intravascular lithotripsy (IVL) is an emerging therapy for the modification of coronary artery calcification (CAC). Data on its use in several clinical and lesion subsets are limited due to their exclusion from preapproval trials. METHODS We performed a retrospective review of patients who were excluded from preapproval trials of coronary IVL and underwent CAC modification with the off-label use of a peripheral IVL system. The primary outcome was a composite of procedural success, defined as residual stenosis <10%, and no major adverse cardiac event (MACE), ie, cardiac death, myocardial infarction, or target- vessel revascularization, in hospital and at 30 days. RESULTS Between June 2019 and April 2020, a total of 9 patients who underwent off-label coronary IVL were identified. Exclusion criteria from preapproval trials included a target lesion within an unprotected left main coronary artery (ULMCA; n = 3) and/or ostial location (n = 5), a target lesion involving in-stent restenosis (n = 3), a second target-vessel lesion with >50% stenosis (n = 1), and/or New York Heart Association class III/IV heart failure (n = 5). The primary outcome was achieved in 8 patients. MACE rate was 0% in hospital and at 30 days. For ULMCA lesions (n = 3), residual stenosis was 0% in 2 patients and 10% in 1 patient. For right coronary artery lesions (n = 3), residual stenosis was 0% in 2 patients and 40% in 1 patient. For left anterior descending coronary artery lesions (n = 3), residual stenosis was 0% in all patients. CONCLUSION Coronary IVL with a peripheral IVL system may be an effective therapy for CAC modification within ULMCA disease, ostial disease, in-stent restenosis, and New York Heart Association class III/IV heart failure.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Daniel R Schimmel
- Bluhm Cardiovascular Institute, Northwestern Medicine, Galter Pavilion, 675 N St Clair St, Ste 19-100, Chicago, IL 60611 USA.
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Khan MR, Kayani WT, Ahmad W, Manan M, Hira RS, Hamzeh I, Jneid H, Virani SS, Kleiman N, Lakkis N, Alam M. Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta-analysis and meta-regression. Clin Cardiol 2019; 42:1071-1078. [PMID: 31486094 PMCID: PMC6837018 DOI: 10.1002/clc.23253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 11/11/2022] Open
Abstract
Background Older adults (≥70‐year‐old) are under‐represented in the published data pertaining to unprotected left main coronary artery disease (ULMCAD). Hypothesis: Percutaneous coronary intervention (PCI) might be comparable to coronary artery bypass grafting (CABG) for revascularization of ULMCAD. Methods We compared PCI versus CABG in older adults with ULMCAD with an aggregate data meta‐analyses (4880 patients) of clinical outcomes [all‐cause mortality, myocardial infarction (MI), repeat revascularization, stroke and major adverse cardiac and cerebrovascular events(MACCE)] at 30 days, 12‐24 months & ≥36 months in patients with mean age ≥70 years and ULMCAD. A meta‐regression analysis evaluated the effect of age on mortality after PCI. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using random‐effects model. Results All‐cause mortality between PCI and CABG was comparable at 30‐days (OR0.77, 95% CI 0.42‐ 1.41) and 12‐24‐months (OR 1.22, 95% CI 0.78‐1.93). PCI was associated with a markedly lower rate of stroke at 30‐day follow‐up in octogenarians (OR 0.14, 95% CI 0.02‐0.76) but an overall higher rate of repeat revascularization. At ≥36‐months, MACCE (OR 1.26,95% CI 0.99‐1.60) and all‐cause mortality (OR 1.39, 95% CI 1.00‐1.93) showed a trend favoring CABG but did not reach statistical significance. On meta‐regression, PCI was associated with a higher mortality with advancing age (coefficient=0.1033, p=0.042). Conclusions PCI was associated with a markedly lower rate of early stroke in octogenarians as compared to CABG. All‐cause mortality was comparable between the two arms with a trend favoring CABG at ≥36‐months.PCI was however associated with increasing mortality with advancing age as compared to CABG.
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Affiliation(s)
- Mahin R Khan
- Division of Cardiology, McLaren-Flint/Michigan State University, Flint, Michigan
| | - Waleed T Kayani
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Waqas Ahmad
- Department of Internal Medicine, Nishtar Medical University, Multan, Pakistan
| | - Malalai Manan
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Ravi S Hira
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Ihab Hamzeh
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Hani Jneid
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Salim S Virani
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Neal Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Nasser Lakkis
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Mahboob Alam
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
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Merella P, Lorenzoni G, Viola G, Berne P, Casu G. Rendered OCT Imaging of an Impressive Stent Malapposition in the Left Main Coronary Artery. J Invasive Cardiol 2019; 31:E280-E281. [PMID: 31478900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This case emphasizes the need to use intravascular imaging to optimize stent implantation in the left main coronary artery. Despite recommendations, intravascular imaging is still widely under-utilized. The recently developed stent apposition OCT software (OPTIS Stent Optimization Software; Abbott Vascular) confirmed its usefulness in optimizing stent implantation in unprotected left main PCI.
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Affiliation(s)
- Pierluigi Merella
- Ospedale San Francesco, Unità Operativa Complessa di Cardiologia, via Mannironi 1, Nuoro, Italy.
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8
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Xu L, Sun H, Wang LF, Yang XC, Li KB, Zhang DP, Wang HS, Li WM. Long-term prognosis of patients with acute myocardial infarction due to unprotected left main coronary artery disease: a single-centre experience over 14 years. Singapore Med J 2017; 57:396-400. [PMID: 27439434 DOI: 10.11622/smedj.2016121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Acute myocardial infarction (AMI) due to unprotected left main coronary artery (ULMCA) disease is clinically catastrophic although it has a low incidence. Studies on the long-term prognosis of these patients are rare. METHODS From January 1999 to September 2013, 55 patients whose infarct-related artery was the ULMCA were enrolled. Clinical, angiographic and interventional data was collected. Short-term and long-term clinical follow-up results as well as prognostic determinants during hospitalisation and follow-up were analysed. RESULTS Cardiogenic shock (CS) occurred in 30 (54.5%) patients. During hospitalisation, 22 (40.0%) patients died. Multivariate logistic regression analysis showed that CS (odds ratio [OR] 5.86; p = 0.03), collateral circulation of Grade 2 or 3 (OR 0.14; p = 0.02) and final flow of thrombolysis in myocardial infarction (TIMI) Grade 3 (OR 0.05; p = 0.03) correlated with death during hospitalisation. 33 patients survived to discharge; another seven patients died during the follow-up period of 44.6 ± 31.3 (median 60, range 0.67-117.00) months. The overall mortality rate was 52.7% (n = 29). Kaplan-Meier analysis showed that the total cumulative survival rate was 30.7%. Cox multivariate regression analysis showed that CS during hospitalisation was the only predictor of overall mortality (hazard ratio 4.07, 95% confidence interval 1.40-11.83; p = 0.01). CONCLUSION AMI caused by ULMCA lesions is complicated by high incidence of CS and mortality. CS, poor collateral blood flow and failure to restore final flow of TIMI Grade 3 correlated with death during hospitalisation. CS is the only predictor of long-term overall mortality.
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Affiliation(s)
- Li Xu
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hao Sun
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Le-Feng Wang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xin-Chun Yang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kui-Bao Li
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Da-Peng Zhang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hong-Shi Wang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wei-Ming Li
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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