Frontiers in cardiovascular medicine · 2026
Outcome of contemporary unprotected left main percutaneous coronary intervention in patients with acute myocardial infarction.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Kim Hong Nyun, Lee Jang Hoon, Park Bo Eun, Park Yoon Jung, Park Jong Sung, Kim Nam Kyun, Wi Youngjun, Yang Dong Heon, Park Hun Sik, Cho Yongkeun, Jeong Myung Ho, Park Jong-Seon
Аннотация
BACKGROUND: Limited data are available on clinical characteristics and outcomes in patients with culprit or non-culprit left main coronary artery (LMCA) stenosis between ST-segment elevation myocardial infarction (STEMI) and non-STEMI.
METHODS: This study aimed to compare treatment pattern and outcome between STEMI and non-STEMI according to culprit and non-culprit LMCA stenosis. We examined 572 patients with LMCA stenosis from the Korean Acute Myocardial Infarction Registry-National Institute of Health database. Major adverse cardiac and cerebrovascular events (MACCE) were defined as all-cause death, nonfatal myocardial infarction (MI), repeat revascularization, cerebrovascular accident, rehospitalizations, and stent thrombosis.
RESULTS: In patients with culprit LMCA stenosis, cardiogenic shock (50.5% vs. 12.1%; P < 0.001) and use of mechanical hemodynamic support (48.5% vs. 11.0%; P < 0.001) were significantly greater in STEMI than in non-STEMI. In-hospital mortality (32.3% vs. 8.1%, P < 0.001) and 3-year MACCE (56.6% vs. 42.2%; log-rank P = 0.003) were significantly higher in STEMI. Intravascular ultrasound improved outcomes of culprit LMCA stenosis (23.1% vs. 68.1%, log-rank P = 0.001). Acute kidney injury, multiple organ failure, and cardiopulmonary resuscitation were independently associated with MACCE in STEMI. In patients with non-culprit LMCA stenosis, there were no significant differences in MACCE between STEMI and non-STEMI (31.3% vs. 34.8%, log-rank P = 0.530). Concurrent percutaneous coronary intervention (PCI) for non-culprit LMCA stenosis during PCI for other culprit vessel segments did not improve MACCE in STEMI (29.5% vs. 32.9%; log-rank P = 0.660).
CONCLUSIONS: PCI for culprit LMCA stenosis is challenging in both STEMI and non-STEMI despite appropriate mechanical hemodynamic support. Concurrent PCI for non-culprit LMCA stenosis in STEMI does not improve MACCE.
METHODS: This study aimed to compare treatment pattern and outcome between STEMI and non-STEMI according to culprit and non-culprit LMCA stenosis. We examined 572 patients with LMCA stenosis from the Korean Acute Myocardial Infarction Registry-National Institute of Health database. Major adverse cardiac and cerebrovascular events (MACCE) were defined as all-cause death, nonfatal myocardial infarction (MI), repeat revascularization, cerebrovascular accident, rehospitalizations, and stent thrombosis.
RESULTS: In patients with culprit LMCA stenosis, cardiogenic shock (50.5% vs. 12.1%; P < 0.001) and use of mechanical hemodynamic support (48.5% vs. 11.0%; P < 0.001) were significantly greater in STEMI than in non-STEMI. In-hospital mortality (32.3% vs. 8.1%, P < 0.001) and 3-year MACCE (56.6% vs. 42.2%; log-rank P = 0.003) were significantly higher in STEMI. Intravascular ultrasound improved outcomes of culprit LMCA stenosis (23.1% vs. 68.1%, log-rank P = 0.001). Acute kidney injury, multiple organ failure, and cardiopulmonary resuscitation were independently associated with MACCE in STEMI. In patients with non-culprit LMCA stenosis, there were no significant differences in MACCE between STEMI and non-STEMI (31.3% vs. 34.8%, log-rank P = 0.530). Concurrent percutaneous coronary intervention (PCI) for non-culprit LMCA stenosis during PCI for other culprit vessel segments did not improve MACCE in STEMI (29.5% vs. 32.9%; log-rank P = 0.660).
CONCLUSIONS: PCI for culprit LMCA stenosis is challenging in both STEMI and non-STEMI despite appropriate mechanical hemodynamic support. Concurrent PCI for non-culprit LMCA stenosis in STEMI does not improve MACCE.