Vol 20, No 2 (2013)
Original articles
Published online: 2013-04-05
Acute myocardial infarction due to left main coronary artery disease: A large multicenter national registry
DOI: 10.5603/CJ.2013.0033
Cardiol J 2013;20(2):190-196.
Abstract
Background: Optimal management of patients with acute myocardial infarction (MI) due
to critical stenosis of an unprotected left main coronary artery (ULMCA) is not established.
However, data from observational studies and registries encourage to perform percutaneous
coronary intervention (PCI) in high risk patients. We investigated gender-related discrepancies,
clinical course and prognosis in patients with acute MI and ULMCA as an infarct-related
artery.
Methods: A total of 643 consecutive patients (184 [28.6%] females and 459 [71.4%] males)
with acute MI due to critical ULMCA stenosis were selected from the population of 121,526
patients hospitalized due to acute coronary syndromes between 2003 and 2006. The primary
endpoints were in-hospital, 30-day, 6-month and 12-month mortality.
Results: Women were older than men with signifi cantly higher proportion of women older
than 65 and with unfavorable risk profi le. The management in men and women was similar.
There was no signifi cant gender-related differences in mortality in all follow-up periods. In
multivariate analysis cardiogenic shock, pulmonary edema, ST elevation myocardial infarction
(STEMI) and advanced age signifi cantly increased mortality, whereas successful PCI
decreased mortality.
Conclusions: No signifi cant differences in clinical course, treatment and prognosis between
men and women were noted. Mortality remained very high in both genders. The most unfavorable
prognostic factors were cardiogenic shock, pulmonary edema, STEMI and advanced
age. Percutaneous coronary angioplasty is feasible and offers high success rate in this subset of
patients.
to critical stenosis of an unprotected left main coronary artery (ULMCA) is not established.
However, data from observational studies and registries encourage to perform percutaneous
coronary intervention (PCI) in high risk patients. We investigated gender-related discrepancies,
clinical course and prognosis in patients with acute MI and ULMCA as an infarct-related
artery.
Methods: A total of 643 consecutive patients (184 [28.6%] females and 459 [71.4%] males)
with acute MI due to critical ULMCA stenosis were selected from the population of 121,526
patients hospitalized due to acute coronary syndromes between 2003 and 2006. The primary
endpoints were in-hospital, 30-day, 6-month and 12-month mortality.
Results: Women were older than men with signifi cantly higher proportion of women older
than 65 and with unfavorable risk profi le. The management in men and women was similar.
There was no signifi cant gender-related differences in mortality in all follow-up periods. In
multivariate analysis cardiogenic shock, pulmonary edema, ST elevation myocardial infarction
(STEMI) and advanced age signifi cantly increased mortality, whereas successful PCI
decreased mortality.
Conclusions: No signifi cant differences in clinical course, treatment and prognosis between
men and women were noted. Mortality remained very high in both genders. The most unfavorable
prognostic factors were cardiogenic shock, pulmonary edema, STEMI and advanced
age. Percutaneous coronary angioplasty is feasible and offers high success rate in this subset of
patients.
Keywords: acute coronary syndromeleft main coronary arterymortalitytherapeutic strategygender
