Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention
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. Between January 2000 and...
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| Veröffentlicht in: | The American heart journal 2018-05, Vol.199, p.156-162 |
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| creator | Gharacholou, S. Michael Ijioma, Nkechinyere N. Lennon, Ryan J. Rihal, Charanjit S. Bell, Malcolm R. Brenes-Salazar, Jorge A. Sandhu, Gurpreet S. Gulati, Rajiv Pellikka, Patricia A. Pollak, Peter M. Lane, Gary E. Pillai, Dilip P. Munoz, Freddy Del-Carpio Motiei, Arashk Singh, Mandeep |
| description | 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.
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.
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).
Unprotected culprit LMCAD ACS necessitating PCI is uncommon, occurring in |
| doi_str_mv | 10.1016/j.ahj.2018.02.012 |
| format | Article |
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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.
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).
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.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2018.02.012</identifier><identifier>PMID: 29754655</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute coronary syndromes ; Angina ; Angioplasty ; Blood clots ; Cardiovascular disease ; Clinical outcomes ; Clinical trials ; Coronary artery ; Coronary artery disease ; Coronary vessels ; Heart attacks ; Heart diseases ; Hospitalization ; Hypertension ; Intervention ; Myocardial infarction ; Patients ; Survival</subject><ispartof>The American heart journal, 2018-05, Vol.199, p.156-162</ispartof><rights>2018</rights><rights>Copyright © 2018. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited May 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c381t-71d39fb29c1ac2841a1beae1d6fe17afa8331b487647e8f6f7539236a66b7ef53</citedby><cites>FETCH-LOGICAL-c381t-71d39fb29c1ac2841a1beae1d6fe17afa8331b487647e8f6f7539236a66b7ef53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002870318300553$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29754655$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gharacholou, S. Michael</creatorcontrib><creatorcontrib>Ijioma, Nkechinyere N.</creatorcontrib><creatorcontrib>Lennon, Ryan J.</creatorcontrib><creatorcontrib>Rihal, Charanjit S.</creatorcontrib><creatorcontrib>Bell, Malcolm R.</creatorcontrib><creatorcontrib>Brenes-Salazar, Jorge A.</creatorcontrib><creatorcontrib>Sandhu, Gurpreet S.</creatorcontrib><creatorcontrib>Gulati, Rajiv</creatorcontrib><creatorcontrib>Pellikka, Patricia A.</creatorcontrib><creatorcontrib>Pollak, Peter M.</creatorcontrib><creatorcontrib>Lane, Gary E.</creatorcontrib><creatorcontrib>Pillai, Dilip P.</creatorcontrib><creatorcontrib>Munoz, Freddy Del-Carpio</creatorcontrib><creatorcontrib>Motiei, Arashk</creatorcontrib><creatorcontrib>Singh, Mandeep</creatorcontrib><title>Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>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.
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.
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).
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.</description><subject>Acute coronary syndromes</subject><subject>Angina</subject><subject>Angioplasty</subject><subject>Blood clots</subject><subject>Cardiovascular disease</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Coronary artery</subject><subject>Coronary artery disease</subject><subject>Coronary vessels</subject><subject>Heart attacks</subject><subject>Heart diseases</subject><subject>Hospitalization</subject><subject>Hypertension</subject><subject>Intervention</subject><subject>Myocardial infarction</subject><subject>Patients</subject><subject>Survival</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kc2u1CAYhonReMajF-DGkLhx0wq0BSauzMS_5CRudE0ofDg0LYxAj5nL8g5l7NGTuHBFIM_7AN-L0HNKWkoofz21-ji1jFDZEtYSyh6gHSV70XDR9w_RjhDCGilId4We5DzVLWeSP0ZXbC-Gng_DDv08HHXSpkDyuXiTsQ4WzzF8w_VowXEtJi6QcXT4pIuHUDL-4csRa7MWwCamGHQ643wONv0m7Qq4RGzW-ZR8wTO4ghftwz2rU3WfsfUZdK5wAl3AbtoTpCrWAeKa7xM-1MRtvdzH8BQ9cnrO8OxuvUZf37_7cvjY3Hz-8Onw9qYxnaSlEdR2ezeyvaHaMNlTTUfQQC13QIV2WnYdHXspeC9AOu7E0O1ZxzXnowA3dNfo1eY9pfh9hVzU4rOBed4epxjp6mhlL2lFX_6DTnFNob7uQglCBJcXId0ok2LOCZyqA1rq9xQl6tKnmlTtU136VISp2mfNvLgzr-MC9m_iT4EVeLMBUEdx6yGpbGpLBqxPYIqy0f9H_wtv8rWq</recordid><startdate>201805</startdate><enddate>201805</enddate><creator>Gharacholou, S. Michael</creator><creator>Ijioma, Nkechinyere N.</creator><creator>Lennon, Ryan J.</creator><creator>Rihal, Charanjit S.</creator><creator>Bell, Malcolm R.</creator><creator>Brenes-Salazar, Jorge A.</creator><creator>Sandhu, Gurpreet S.</creator><creator>Gulati, Rajiv</creator><creator>Pellikka, Patricia A.</creator><creator>Pollak, Peter M.</creator><creator>Lane, Gary E.</creator><creator>Pillai, Dilip P.</creator><creator>Munoz, Freddy Del-Carpio</creator><creator>Motiei, Arashk</creator><creator>Singh, Mandeep</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201805</creationdate><title>Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention</title><author>Gharacholou, S. Michael ; Ijioma, Nkechinyere N. ; Lennon, Ryan J. ; Rihal, Charanjit S. ; Bell, Malcolm R. ; Brenes-Salazar, Jorge A. ; Sandhu, Gurpreet S. ; Gulati, Rajiv ; Pellikka, Patricia A. ; Pollak, Peter M. ; Lane, Gary E. ; Pillai, Dilip P. ; Munoz, Freddy Del-Carpio ; Motiei, Arashk ; Singh, Mandeep</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c381t-71d39fb29c1ac2841a1beae1d6fe17afa8331b487647e8f6f7539236a66b7ef53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acute coronary syndromes</topic><topic>Angina</topic><topic>Angioplasty</topic><topic>Blood clots</topic><topic>Cardiovascular disease</topic><topic>Clinical outcomes</topic><topic>Clinical trials</topic><topic>Coronary artery</topic><topic>Coronary artery disease</topic><topic>Coronary vessels</topic><topic>Heart attacks</topic><topic>Heart diseases</topic><topic>Hospitalization</topic><topic>Hypertension</topic><topic>Intervention</topic><topic>Myocardial infarction</topic><topic>Patients</topic><topic>Survival</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gharacholou, S. 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Michael</au><au>Ijioma, Nkechinyere N.</au><au>Lennon, Ryan J.</au><au>Rihal, Charanjit S.</au><au>Bell, Malcolm R.</au><au>Brenes-Salazar, Jorge A.</au><au>Sandhu, Gurpreet S.</au><au>Gulati, Rajiv</au><au>Pellikka, Patricia A.</au><au>Pollak, Peter M.</au><au>Lane, Gary E.</au><au>Pillai, Dilip P.</au><au>Munoz, Freddy Del-Carpio</au><au>Motiei, Arashk</au><au>Singh, Mandeep</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2018-05</date><risdate>2018</risdate><volume>199</volume><spage>156</spage><epage>162</epage><pages>156-162</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><abstract>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.
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.
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).
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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29754655</pmid><doi>10.1016/j.ahj.2018.02.012</doi><tpages>7</tpages></addata></record> |
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| source | Elsevier ScienceDirect Journals |
| subjects | Acute coronary syndromes Angina Angioplasty Blood clots Cardiovascular disease Clinical outcomes Clinical trials Coronary artery Coronary artery disease Coronary vessels Heart attacks Heart diseases Hospitalization Hypertension Intervention Myocardial infarction Patients Survival |
| title | Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention |
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