Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention

Shahyar Gharacholou, Nkechinyere N. Ijioma, Ryan J. Lennon, Charanjit Rihal, Malcolm R. Bell, Jorge A. Brenes-Salazar, Gurpreet S Sandhu, Rajiv Gulati, Patricia Pellikka, Peter M. Pollak, Gary E. Lane, Dilip P. Pillai, Freddy Del Carpio Munoz, Arashk Motiei, Mandeep Singh

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Patients with acute coronary syndrome (ACS) due to unprotected culprit left main coronary artery disease (LMCAD) treated with percutaneous coronary intervention (PCI) are rare, high-risk, and not represented in trials. Data regarding long term outcome after PCI are limited. Methods: Between January 2000 and December 2014, there were 8,794 patients hospitalized with unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) or ST-elevation myocardial infarction (STEMI) treated with PCI at our institution; of these, 83 (0.94%) patients were identified as having culprit LMCAD ACS. Results: Of the 83 patients with unprotected LMCAD ACS, 40 patients presented with STEMI and 43 patients presented with UA/NSTEMI. As compared to LM UA/NSTEMI, LM STEMI patients were younger and had less hypertension, with a trend towards greater frequency of cardiogenic shock. Distal LM involvement was common in both groups and did not differ by ACS type. In-hospital mortality was 33% in LM STEMI and 9% in LM UA/NSTEMI (P =.009). Over median follow up of 6.3 years, long term survival rates in both groups were similar (46% for STEMI vs 51% for UA/NSTEMI; P =.50 by log-rank). Conclusions: Unprotected culprit LMCAD ACS necessitating PCI is uncommon, occurring in <1% of cases, but is associated with reduced survival, with long term follow-up noting continued and similar risk of death regardless of index ACS type.

Original languageEnglish (US)
Pages (from-to)156-162
Number of pages7
JournalAmerican Heart Journal
Volume199
DOIs
StatePublished - May 1 2018

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Percutaneous Coronary Intervention
Acute Coronary Syndrome
Coronary Artery Disease
Unstable Angina
Cardiogenic Shock
Hospital Mortality
Survival Rate
ST Elevation Myocardial Infarction
Non-ST Elevated Myocardial Infarction
Hypertension
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention. / Gharacholou, Shahyar; Ijioma, Nkechinyere N.; Lennon, Ryan J.; Rihal, Charanjit; Bell, Malcolm R.; Brenes-Salazar, Jorge A.; Sandhu, Gurpreet S; Gulati, Rajiv; Pellikka, Patricia; Pollak, Peter M.; Lane, Gary E.; Pillai, Dilip P.; Munoz, Freddy Del Carpio; Motiei, Arashk; Singh, Mandeep.

In: American Heart Journal, Vol. 199, 01.05.2018, p. 156-162.

Research output: Contribution to journalArticle

Gharacholou, Shahyar ; Ijioma, Nkechinyere N. ; Lennon, Ryan J. ; Rihal, Charanjit ; Bell, Malcolm R. ; Brenes-Salazar, Jorge A. ; Sandhu, Gurpreet S ; Gulati, Rajiv ; Pellikka, Patricia ; Pollak, Peter M. ; Lane, Gary E. ; Pillai, Dilip P. ; Munoz, Freddy Del Carpio ; Motiei, Arashk ; Singh, Mandeep. / Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention. In: American Heart Journal. 2018 ; Vol. 199. pp. 156-162.
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abstract = "Background: Patients with acute coronary syndrome (ACS) due to unprotected culprit left main coronary artery disease (LMCAD) treated with percutaneous coronary intervention (PCI) are rare, high-risk, and not represented in trials. Data regarding long term outcome after PCI are limited. Methods: Between January 2000 and December 2014, there were 8,794 patients hospitalized with unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) or ST-elevation myocardial infarction (STEMI) treated with PCI at our institution; of these, 83 (0.94{\%}) patients were identified as having culprit LMCAD ACS. Results: Of the 83 patients with unprotected LMCAD ACS, 40 patients presented with STEMI and 43 patients presented with UA/NSTEMI. As compared to LM UA/NSTEMI, LM STEMI patients were younger and had less hypertension, with a trend towards greater frequency of cardiogenic shock. Distal LM involvement was common in both groups and did not differ by ACS type. In-hospital mortality was 33{\%} in LM STEMI and 9{\%} in LM UA/NSTEMI (P =.009). Over median follow up of 6.3 years, long term survival rates in both groups were similar (46{\%} for STEMI vs 51{\%} for UA/NSTEMI; P =.50 by log-rank). Conclusions: Unprotected culprit LMCAD ACS necessitating PCI is uncommon, occurring in <1{\%} of cases, but is associated with reduced survival, with long term follow-up noting continued and similar risk of death regardless of index ACS type.",
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T1 - Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention

AU - Gharacholou, Shahyar

AU - Ijioma, Nkechinyere N.

AU - Lennon, Ryan J.

AU - Rihal, Charanjit

AU - Bell, Malcolm R.

AU - Brenes-Salazar, Jorge A.

AU - Sandhu, Gurpreet S

AU - Gulati, Rajiv

AU - Pellikka, Patricia

AU - Pollak, Peter M.

AU - Lane, Gary E.

AU - Pillai, Dilip P.

AU - Munoz, Freddy Del Carpio

AU - Motiei, Arashk

AU - Singh, Mandeep

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: Patients with acute coronary syndrome (ACS) due to unprotected culprit left main coronary artery disease (LMCAD) treated with percutaneous coronary intervention (PCI) are rare, high-risk, and not represented in trials. Data regarding long term outcome after PCI are limited. Methods: Between January 2000 and December 2014, there were 8,794 patients hospitalized with unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) or ST-elevation myocardial infarction (STEMI) treated with PCI at our institution; of these, 83 (0.94%) patients were identified as having culprit LMCAD ACS. Results: Of the 83 patients with unprotected LMCAD ACS, 40 patients presented with STEMI and 43 patients presented with UA/NSTEMI. As compared to LM UA/NSTEMI, LM STEMI patients were younger and had less hypertension, with a trend towards greater frequency of cardiogenic shock. Distal LM involvement was common in both groups and did not differ by ACS type. In-hospital mortality was 33% in LM STEMI and 9% in LM UA/NSTEMI (P =.009). Over median follow up of 6.3 years, long term survival rates in both groups were similar (46% for STEMI vs 51% for UA/NSTEMI; P =.50 by log-rank). Conclusions: Unprotected culprit LMCAD ACS necessitating PCI is uncommon, occurring in <1% of cases, but is associated with reduced survival, with long term follow-up noting continued and similar risk of death regardless of index ACS type.

AB - Background: Patients with acute coronary syndrome (ACS) due to unprotected culprit left main coronary artery disease (LMCAD) treated with percutaneous coronary intervention (PCI) are rare, high-risk, and not represented in trials. Data regarding long term outcome after PCI are limited. Methods: Between January 2000 and December 2014, there were 8,794 patients hospitalized with unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) or ST-elevation myocardial infarction (STEMI) treated with PCI at our institution; of these, 83 (0.94%) patients were identified as having culprit LMCAD ACS. Results: Of the 83 patients with unprotected LMCAD ACS, 40 patients presented with STEMI and 43 patients presented with UA/NSTEMI. As compared to LM UA/NSTEMI, LM STEMI patients were younger and had less hypertension, with a trend towards greater frequency of cardiogenic shock. Distal LM involvement was common in both groups and did not differ by ACS type. In-hospital mortality was 33% in LM STEMI and 9% in LM UA/NSTEMI (P =.009). Over median follow up of 6.3 years, long term survival rates in both groups were similar (46% for STEMI vs 51% for UA/NSTEMI; P =.50 by log-rank). Conclusions: Unprotected culprit LMCAD ACS necessitating PCI is uncommon, occurring in <1% of cases, but is associated with reduced survival, with long term follow-up noting continued and similar risk of death regardless of index ACS type.

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JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

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