Objectives.

The goal of our single center registry was to analysis in-hospital and 180 days outcomes of patients (pts) with STEMI undergoing emergency PCI of left main coronary artery (LMCA) occlusion as a culprit lesion.

Background:

Pts with ST-segment elevation myocardial infarction (STEMI) due to left main coronary artery occlusion (LMCAO) represent a rare group of pts with poor prognosis. They often present with cardiogenic shock (CS). Despite the lack evidence, percutaneous coronary intervention (PCI) is the preferred strategy of myocardial revascularization in an acute setting.

Methods and results:

We analyzed the repeat revascularization, in-stent-restenosis and all-cause mortality after 180 days of pts with STEMI (or STEMI equivalent ECG) undergoing emergency PCI due to LMCA occlusion at our center between march 2020 and march 2022. All PCI data (n=2281) in this period were analyzed. Of those, 29 pts had STEMI or a STEMI equivalent ECG pattern and LMCA occlusion as culprit lesion and treated by primary PCI. 7/29 (25.3%) pts were female, mean age was 73.6 ± 13.5 years. Prehospital and intrahospital cardiopulmonary resuscitation (CPR) was necessary in 27.6% (8 pts), 62.5 % (5 pts) of those longer than 30 minutes. (17pts) 58.6% pts had CS on admission and in 6 pts (20.6 %) applied left ventricular circulatory support using the coaxial Impella® pump or extracorporeal membrane oxygenation (ECMO). Primary PCI was successful in 82.7% of the patients.

In-hospital mortality was 48.3%. 90% of the CPR patients and 76.5% of the CS patients died during hospitalization. Repeat revascularization was performed only in 2.6% (1 pts) of pts and 180 days mortality was 55,5% (16 pts).

Conclusions:

Patients with STEMI and LMCA occlusion as the culprit lesion require emergency cardiac catheterization. Mortality of patients with STEMI due to LMCA occlusion is high. Moreover, mortality increased in our analysis with the presence of CPR or CS despite the frequent use of mechanical left ventricular circulatory support systems.