Outcomes of primary percutaneous coronary intervention in acute myocardial infarction due to unprotected left main thrombosis

The Asia-Pacific Left Main ST-Elevation Registry (ASTER)

Jonathan Yap, Gagan Singh, Jung Sun Kim, Krishan Soni, Kelvin Chua, Alvin Neo, Choong Hou Koh, Ehrin J. Armstrong, Stephen W. Waldo, Kendrick A. Shunk, Reginald Low, Myeong Ki Hong, Yangsoo Jang, Khung Keong Yeo

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction: Prior studies of ULM STEMI have been confined to small cohorts. Recent registry data with larger patient cohorts have shown contrasting results. We aim to study the outcomes of patients with unprotected left main (ULM) ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Methods: The Asia-pacific left main ST-Elevation Registry (ASTER) is a multicenter retrospective registry involving 4 sites in Singapore, South Korea, and the United States. The registry included patients presenting with STEMI due to an ULM coronary artery culprit lesion who underwent emergency PCI. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events. Results: A total of 67 patients (mean age 64.2±12.8 years, 53 [79.1%] males) were included. The distal left main bifurcation was most commonly involved (85%, n=57). Fifty one (76%) patients had TIMI 3 flow post-PCI. The in-hospital mortality rate was 47.8% (n=32); 61% (n=41) had cardiac failure, 4% (n=3) had emergency coronary artery bypass grafting, 1% (n=1) had a re-infarction, 3% (n=2) had stroke and 55% (n=37) had malignant ventricular arrhythmias. On multivariate analysis, predictors of in-hospital mortality included older age (odds ratio (OR) 1.085 (95% confidence interval (CI) 1.002-1.175), P=0.044), diabetes mellitus (OR 10.882 (95%CI 11.074-110.287), P=0.043) and absence of post-PCI TIMI 3 flow (OR 71.429 (95%CI 2.985-1000), P=0.008). Conclusions: STEMI from culprit unprotected left main coronary artery stenosis is associated with significant mortality and morbidity. Emergency PCI provides an important treatment option in this high-risk group, but in-hospital mortality remains high.

Original languageEnglish (US)
JournalJournal of Interventional Cardiology
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Percutaneous Coronary Intervention
Registries
Hospital Mortality
Thrombosis
Myocardial Infarction
Emergencies
Odds Ratio
Confidence Intervals
Republic of Korea
Mortality
Coronary Stenosis
Singapore
Coronary Artery Bypass
Infarction
Cardiac Arrhythmias
Coronary Vessels
Diabetes Mellitus
Multivariate Analysis
Heart Failure
Stroke

Keywords

  • Acute coronary syndromes
  • Complex coronary interventions
  • Mortality

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes of primary percutaneous coronary intervention in acute myocardial infarction due to unprotected left main thrombosis : The Asia-Pacific Left Main ST-Elevation Registry (ASTER). / Yap, Jonathan; Singh, Gagan; Kim, Jung Sun; Soni, Krishan; Chua, Kelvin; Neo, Alvin; Koh, Choong Hou; Armstrong, Ehrin J.; Waldo, Stephen W.; Shunk, Kendrick A.; Low, Reginald; Hong, Myeong Ki; Jang, Yangsoo; Yeo, Khung Keong.

In: Journal of Interventional Cardiology, 01.01.2017.

Research output: Contribution to journalArticle

Yap, Jonathan ; Singh, Gagan ; Kim, Jung Sun ; Soni, Krishan ; Chua, Kelvin ; Neo, Alvin ; Koh, Choong Hou ; Armstrong, Ehrin J. ; Waldo, Stephen W. ; Shunk, Kendrick A. ; Low, Reginald ; Hong, Myeong Ki ; Jang, Yangsoo ; Yeo, Khung Keong. / Outcomes of primary percutaneous coronary intervention in acute myocardial infarction due to unprotected left main thrombosis : The Asia-Pacific Left Main ST-Elevation Registry (ASTER). In: Journal of Interventional Cardiology. 2017.
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abstract = "Introduction: Prior studies of ULM STEMI have been confined to small cohorts. Recent registry data with larger patient cohorts have shown contrasting results. We aim to study the outcomes of patients with unprotected left main (ULM) ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Methods: The Asia-pacific left main ST-Elevation Registry (ASTER) is a multicenter retrospective registry involving 4 sites in Singapore, South Korea, and the United States. The registry included patients presenting with STEMI due to an ULM coronary artery culprit lesion who underwent emergency PCI. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events. Results: A total of 67 patients (mean age 64.2±12.8 years, 53 [79.1{\%}] males) were included. The distal left main bifurcation was most commonly involved (85{\%}, n=57). Fifty one (76{\%}) patients had TIMI 3 flow post-PCI. The in-hospital mortality rate was 47.8{\%} (n=32); 61{\%} (n=41) had cardiac failure, 4{\%} (n=3) had emergency coronary artery bypass grafting, 1{\%} (n=1) had a re-infarction, 3{\%} (n=2) had stroke and 55{\%} (n=37) had malignant ventricular arrhythmias. On multivariate analysis, predictors of in-hospital mortality included older age (odds ratio (OR) 1.085 (95{\%} confidence interval (CI) 1.002-1.175), P=0.044), diabetes mellitus (OR 10.882 (95{\%}CI 11.074-110.287), P=0.043) and absence of post-PCI TIMI 3 flow (OR 71.429 (95{\%}CI 2.985-1000), P=0.008). Conclusions: STEMI from culprit unprotected left main coronary artery stenosis is associated with significant mortality and morbidity. Emergency PCI provides an important treatment option in this high-risk group, but in-hospital mortality remains high.",
keywords = "Acute coronary syndromes, Complex coronary interventions, Mortality",
author = "Jonathan Yap and Gagan Singh and Kim, {Jung Sun} and Krishan Soni and Kelvin Chua and Alvin Neo and Koh, {Choong Hou} and Armstrong, {Ehrin J.} and Waldo, {Stephen W.} and Shunk, {Kendrick A.} and Reginald Low and Hong, {Myeong Ki} and Yangsoo Jang and Yeo, {Khung Keong}",
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T1 - Outcomes of primary percutaneous coronary intervention in acute myocardial infarction due to unprotected left main thrombosis

T2 - The Asia-Pacific Left Main ST-Elevation Registry (ASTER)

AU - Yap, Jonathan

AU - Singh, Gagan

AU - Kim, Jung Sun

AU - Soni, Krishan

AU - Chua, Kelvin

AU - Neo, Alvin

AU - Koh, Choong Hou

AU - Armstrong, Ehrin J.

AU - Waldo, Stephen W.

AU - Shunk, Kendrick A.

AU - Low, Reginald

AU - Hong, Myeong Ki

AU - Jang, Yangsoo

AU - Yeo, Khung Keong

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Introduction: Prior studies of ULM STEMI have been confined to small cohorts. Recent registry data with larger patient cohorts have shown contrasting results. We aim to study the outcomes of patients with unprotected left main (ULM) ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Methods: The Asia-pacific left main ST-Elevation Registry (ASTER) is a multicenter retrospective registry involving 4 sites in Singapore, South Korea, and the United States. The registry included patients presenting with STEMI due to an ULM coronary artery culprit lesion who underwent emergency PCI. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events. Results: A total of 67 patients (mean age 64.2±12.8 years, 53 [79.1%] males) were included. The distal left main bifurcation was most commonly involved (85%, n=57). Fifty one (76%) patients had TIMI 3 flow post-PCI. The in-hospital mortality rate was 47.8% (n=32); 61% (n=41) had cardiac failure, 4% (n=3) had emergency coronary artery bypass grafting, 1% (n=1) had a re-infarction, 3% (n=2) had stroke and 55% (n=37) had malignant ventricular arrhythmias. On multivariate analysis, predictors of in-hospital mortality included older age (odds ratio (OR) 1.085 (95% confidence interval (CI) 1.002-1.175), P=0.044), diabetes mellitus (OR 10.882 (95%CI 11.074-110.287), P=0.043) and absence of post-PCI TIMI 3 flow (OR 71.429 (95%CI 2.985-1000), P=0.008). Conclusions: STEMI from culprit unprotected left main coronary artery stenosis is associated with significant mortality and morbidity. Emergency PCI provides an important treatment option in this high-risk group, but in-hospital mortality remains high.

AB - Introduction: Prior studies of ULM STEMI have been confined to small cohorts. Recent registry data with larger patient cohorts have shown contrasting results. We aim to study the outcomes of patients with unprotected left main (ULM) ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Methods: The Asia-pacific left main ST-Elevation Registry (ASTER) is a multicenter retrospective registry involving 4 sites in Singapore, South Korea, and the United States. The registry included patients presenting with STEMI due to an ULM coronary artery culprit lesion who underwent emergency PCI. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events. Results: A total of 67 patients (mean age 64.2±12.8 years, 53 [79.1%] males) were included. The distal left main bifurcation was most commonly involved (85%, n=57). Fifty one (76%) patients had TIMI 3 flow post-PCI. The in-hospital mortality rate was 47.8% (n=32); 61% (n=41) had cardiac failure, 4% (n=3) had emergency coronary artery bypass grafting, 1% (n=1) had a re-infarction, 3% (n=2) had stroke and 55% (n=37) had malignant ventricular arrhythmias. On multivariate analysis, predictors of in-hospital mortality included older age (odds ratio (OR) 1.085 (95% confidence interval (CI) 1.002-1.175), P=0.044), diabetes mellitus (OR 10.882 (95%CI 11.074-110.287), P=0.043) and absence of post-PCI TIMI 3 flow (OR 71.429 (95%CI 2.985-1000), P=0.008). Conclusions: STEMI from culprit unprotected left main coronary artery stenosis is associated with significant mortality and morbidity. Emergency PCI provides an important treatment option in this high-risk group, but in-hospital mortality remains high.

KW - Acute coronary syndromes

KW - Complex coronary interventions

KW - Mortality

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