Abstract 12824: Mortality Outcomes at 30 Days and 1 Year After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Due to Unprotected Left Main Coronary Artery Occlusion

Abstract

Introduction: Patients with acute myocardial infarction (AMI) due to unprotected left main coronary artery (ULMCA) occlusion are often critically ill at presentation. Emergency surgical revascularization is often associated with significant time delay and high mortality risk, as such, primary percutaneous coronary intervention (PCI) has been advocated as the preferred form of reperfusion therapy. Data on the clinical outcomes in this setting however remains limited. Hypothesis: We hypothesised that primary PCI is a feasible revascularization therapy in AMI due to ULMCA occlusion and the identification of the predictors of outcomes would aid in clinical decision-making. Methods: From 2005 to 2015, 71 patients with AMI due to ULMCA occlusion who underwent primary PCI had their outcomes evaluated retrospectively. Given the complex data interrelationships, a generalized structural equation model was applied for identifying the predictors of 30-day and 1-year mortality. All statistical analyses were conducted at 5% level of significance. Results: Majority of the patients (mean age 58.0 ±11.5, 90.1% male) had cardiogenic shock (64.7%) and cardiac arrest (70.1%) and 71.8% were intubated. Procedural success was achieved in 87.3% of patients. Mortality at 30-day was 59.1%, including 16.9% intra-procedural deaths. Cardiogenic shock (Adjusted odds ratio [AOR] 12.1), cardiac arrest (AOR 12.0) and intubation (AOR 282.0) were significantly associated with 30-day mortality. Additionally, a QRS duration of >130 milliseconds on the presenting electrocardiogram was also predictive of cardiogenic shock (AOR 4.5) and 30-day mortality (AOR 10.0). All-cause mortality at 1 year was 63.4% and for which QRS duration >130 milliseconds (AOR 25.4), cardiac arrest (AOR 8.8) and intubation (AOR 16.9) remained predictive of mortality but not cardiogenic shock (AOR 1.8, p >0.05). Conclusion: In conclusion, ULMCA occlusion is associated with a high incidence of 30-day mortality despite successful primary PCI. Patients presenting with a broad QRS complex, cardiogenic shock, cardiac arrest, or requiring intubation have a particularly poor prognosis. However, after thirty days, the mid-term survival rate of the remaining patients appeared favorable.