Abstract 1163 Clinical Outcome of Percutaneous Coronary Intervention in Acute Coronary Syndrome with Left Main Coronary Artery Occlusion

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Clinical Outcome of Percutaneous Coronary Intervention in Acute Coronary Syndrome with Left Main Coronary Artery Occlusion
M. Poudel¹, T. Lawrenz¹, A. I. Diaconescu¹, D. Lawin¹, A. Tego¹, M. Skasa¹, K. Marx¹, C. Stellbrink¹
¹Klinik für Kardiologie und intern. Intensivmedizin, Universitätsklinikum OWL, Bielefeld;
Objectives: We evaluated 180 days all-cause mortality of patients (pts) treated with primary percutaneous coronary intervention (PCI) presenting with acute coronary syndrome (ACS) caused by left main coronary artery (LMCA) occlusion. Background: ACS caused by LMCA occlusion often presents as cardiogenic shock (CS) with a reported incidence of 0.37 to 0.9%. It is associated with high mortality and requires emergency cardiac catheterization (ECC) with PCI of the LMCA as the culprit lesion (CL). The best management approach for LMCA occlusion remains controversial in current guidelines. Emergency coronary artery bypass grafting (CABG), PCI and anticoagulation with different medications have been reported as treatment options. Key point in management is rapid and complete reperfusion of the CL in ACS with CS. Clinical guidelines for ACS with ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation (NSTEMI) recommend primary PCI in hemodynamically unstable pts, because it provides most rapid coronary reperfusion for pts with CS. Methods: All PCI data from march 2020 to march 2022 from our center (n=2281) were analyzed with regard to the presence of ACS caused by LMCA occlusion. Of these, 46 pts had ECC for ACS with LMCA as the CL. Primary endpoint for the analysis was repeat revascularization, in-stent-restenosis and all-cause mortality after 180 days. Results: Mean age was 74.1±12.2 and 36/46 patients (78%) were male; 29 pts (63%) presented with STEMI or STEMI equivalent ECG changes. Prehospital cardiopulmonary resuscitation (CPR) had been performed before ECC in 9 pts (19.5%), with CPR duration > 30 minutes in 3 patients, and intrahospital CPR in 3 pts (6.5%). CS was present in 21 pts (45.7%) and left ventricular circulatory support (Impella® pump or extracorporeal membrane oxygenation) was applied in 7 pts (15.2%). Successful CL revascularization was achieved in 41 pts (89%); in 26 pts (56.5%) a provisional technique with one stent strategy was utilized. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) were used in only 3 pts (6.5%) in this emergency setting. Repeat revascularization was performed only in 4% (2 pts) of patients. In-hospital mortality was 37% (17 pts) and 180 days mortality was 48% (22 pts). Conclusions: ACS caused by LMCA occlusion is rare but frequently associated with CS and CPR and carries substantial mortality. Key point in the management is rapid complete reperfusion of the CL. Pts with LMCA occlusion and CS/CPR have a significantly higher mortality.
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