Abstract 13016: Clinical Outcomes Following Emergent Percutaneous Coronary Intervention for Acute Total/subtotal Occlusion of the Left Main Coronary Artery

Abstract

Introduction: Acute coronary syndrome involving the unprotected left main coronary artery (LMCA) is a fatal event. However, data regarding clinical features and outcomes in patients presenting with acute total/subtotal occlusion of the unprotected LMCA remain limited, and the impact of vital status in the emergency room (ER) remains unknown in such subjects. Methods: From a multi-center registry of 11977 emergent percutaneous coronary interventions (PCIs), 134 patients due to acute total/subtotal occlusion of the unprotected LMCA were reviewed. 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). We evaluated in-hospital mortality and cerebral performance category (CPC) as the endpoints. Results: 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, then of the remaining patients, 52 (85.3%) could be discharged with favorable neurological outcomes (CPC 1 or 2). ER status classification (odds ratio 4.79 [95% confidence interval: 2.39-9.62]; p<0.001) and total occlusion of the unprotected LMCA (odds ratio 5.79 [95% confidence interval 2.27-14.73]; 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 important predictive factors of in-hospital mortality.