Abstract 16866: Complete Revascularization for Left Main Acute Myocardial Infarction

Abstract

Background: In patients presenting with acute myocardial infarction (AMI) with left main (LM) culprit lesion and multivessel disease, percutaneous coronary intervention (PCI) of non-culprit lesions in LM culprit AMI is challenging and whether it reduces mortality and adverse events is unclear. Hypothesis: Complete revascularization will show better outcome than culprit-only revascularization in multi-vessel LM AMI PCI. Methods: We reviewed total of 16831 patients among from July 2016 to June 2020 Korean Acute Myocardial Infarction Registry (KAMIR) and 395 patients were enrolled with LM culprit multi-vessel AMI treated by PCI. We excluded in-hospital death 35 cases then categorized patients whether treated with complete revascularization (n=198) or culprit-only revascularization (n=162). Study outcome was a composite of major cardiac adverse events (MACE) including cardiac death, myocardial infarction, re-PCI, stent thrombosis and rehospitalization due to heart failure. We used propensity score (PS) matching method and cumulative event-free survival and MACE were analyzed over 3 years follow-up. Results: After PS matching, baseline and angiographic characteristics were similar between two groups (Complete group, n=142 versus Culprit-only group, n=142). Killip classification (Class IV : n=13 (9.2%) versus n=14 (9.9%), p -value=0.762) and initial diagnosis (STEMI : n=47 (33.1%) versus n=52 (36.6%), p- value=0.618) at admission were also not different between two groups. There was no difference in MACE between two groups (n=27 (19%) versus n=28 (19.7%), log-rank test p- value = 0.64). Conclusion: Although, other studies had shown better outcome of complete revascularization in multi-vessel AMI, in multi-vessel LM AMI PCI, complete revascularization should be carefully decided depending on the patient's condition.