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Survivors of acute myocardial infarction at left main trunk undergoing primary percutaneous coronary intervention

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Abstract

Acute myocardial infarction (AMI) at left main trunk (LMT) is a deteriorated condition with high in-hospital morbidity and mortality; however, detailed data regarding AMI patients with LMT as culprit lesion (LMT-AMI patients) undergoing primary percutaneous coronary intervention (PCI) has been still limited. Using the AMI-Kyoto Multi-Center Risk Study database, clinical background, angiographic findings and results of primary PCI were retrospectively compared between primary PCI-treated LMT-AMI patients without in-hospital death (survivors, n = 21) and those with in-hospital death (non-survivors, n = 19). The survivors had higher values of estimated glomerular filtration rate (eGFR) and systolic blood pressure at admission and lower prevalence of Killip grade 4 than the non-survivors. Pre-procedural thrombolysis in myocardial infarction (TIMI) flow grade ≥2 at the initial coronary angiography (CAG) and post-procedural TIMI flow grade 3 at the final CAG were more frequent in the survivors, compared with the non-survivors. In contrast, age and gender did not differ significantly between the two groups. On multivariate analysis, higher eGFR and Killip grade 4 at admission were found to be independent in-hospital prognostic factors in the LMT-AMI patients. Admission eGFR and Killip grade 4 are tightly associated with in-hospital prognosis in LMT-AMI patients undergoing primary PCI.

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References

  1. Moosvi AR, Khaja F, Villanueva L, Gheorghiade M, Douthat L, Goldstein S. Early revascularization improves survival in cardiogenic shock complicating acute myocardial infarction. J Am Coll Cardiol. 1992;19:907–14.

    Article  CAS  PubMed  Google Scholar 

  2. Antoniucci D, Valenti R, Santoro GM, Bolognese L, Trapani M, Moschi G, et al. Systematic direct angioplasty and stent-supported direct angioplasty therapy for cardiogenic shock complicating acute myocardial infarction: in-hospital and long-term survival. J Am Coll Cardiol. 1998;31:294–300.

    Article  CAS  PubMed  Google Scholar 

  3. Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med. 1999;341:625–34.

    Article  CAS  PubMed  Google Scholar 

  4. Dauerman HL, Goldberg RJ, White K, Gore JM, Sadiq I, Gurfinkel E, et al. GRACE Investigators. Revascularization, stenting, and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. Am J Cardiol. 2002;90:838–42.

    Article  PubMed  Google Scholar 

  5. Pappalardo A, Mamas MA, Imola F, Ramazzotti V, Manzoli A, Prati F, et al. Percutaneous coronary intervention of unprotected left main coronary artery disease as culprit lesion in patients with acute myocardial infarction. JACC Cardiovasc Interv. 2011;4:618–26.

    Article  PubMed  Google Scholar 

  6. Vis MM, Beijk MA, Grundeken MJ, Baan J Jr, Koch KT, Wykrzykowska JJ, et al. A systematic review and meta-analysis on primary percutaneous coronary intervention of an unprotected left main coronary artery culprit lesion in the setting of acute myocardial infarction. JACC Cardiovasc Interv. 2013;6:317–24.

    Article  PubMed  Google Scholar 

  7. Sakai K, Nakagawa Y, Kimura T, Ando K, Yokoi H, Iwabuchi M, et al. Primary angioplasty of unprotected left main coronary artery for acute anterolateral myocardial infarction. J Invasive Cardiol. 2004;16:621–5.

    PubMed  Google Scholar 

  8. Izumikawa T, Sakamoto S, Takeshita S, Takahashi A, Saito S. Outcomes of primary percutaneous coronary intervention for acute myocardial infarction with unprotected left main coronary artery occlusion. Catheter Cardiovasc Interv. 2012;79:1111–6.

    Article  PubMed  Google Scholar 

  9. Yip HK, Wu CJ, Chen MC, Chang HW, Hsieh KY, Hang CL, et al. Effect of primary angioplasty on total or subtotal left main occlusion: analysis of incidence, clinical features, outcomes, and prognostic determinants. Chest. 2001;120:1212–7.

    Article  CAS  PubMed  Google Scholar 

  10. Neri R, Migliorini A, Moschi G, Valenti R, Dovellini EV, Antoniucci D. Percutaneous reperfusion of left main coronary disease complicated by acute myocardial infarction. Catheter Cardiovasc Interv. 2002;56:31–4.

    Article  PubMed  Google Scholar 

  11. Shiraishi J, Kohno Y, Nakamura T, Yanagiuchi T, Hashimoto S, Ito D, et al. Clinical impact of thrombus aspiration during primary percutaneous coronary intervention in acute myocardial infarction with occluded culprit. Cardiovasc Interv Ther. 2015;30:22–8.

    Article  CAS  PubMed  Google Scholar 

  12. Gillum RF, Fortmann SP, Prineas RJ, Kottke TE. International diagnostic criteria for acute myocardial infarction and acute stroke. Am Heart J. 1984;108:150–8.

    Article  CAS  PubMed  Google Scholar 

  13. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Collaborators developing the Japanese equation for estimated GFR. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.

    Article  CAS  PubMed  Google Scholar 

  14. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation. 1975;51:5–40.

    Article  CAS  PubMed  Google Scholar 

  15. The GUSTO IIb Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. The Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) Angioplasty Substudy Investigators. N Engl J Med. 1997;336:1621–8.

    Article  Google Scholar 

  16. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52:1527–39.

    Article  PubMed  Google Scholar 

  17. Marenzi G, Assanelli E, Campodonico J, De Metrio M, Lauri G, Marana I, et al. Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission. Crit Care Med. 2010;38:438–44.

    Article  PubMed  Google Scholar 

  18. Caruso R, Campolo J, Verde A, Botta L, Cozzi L, Parolini M, et al. Relationship between early inflammatory response and clinical evolution of the severe multiorgan failure in mechanical circulatory support-treated patients. Mediators Inflamm. 2014;. doi:10.1155/2014/281790.

    Google Scholar 

  19. Adams KF Jr, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo, Abraham WT, ADHERE Scientific Advisory Committee and Investigators, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149:209–16.

    Article  PubMed  Google Scholar 

  20. Fonarow GC, Stough WG, Abraham WT, Albert NM, Gheorghiade M, Greenberg BH, OPTIMIZE-HF Investigators and Hospitals, et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol. 2007;50:768–77.

    Article  PubMed  Google Scholar 

  21. Dangas G, Iakovou I, Nikolsky E, Aymong ED, Mintz GS, Kipshidze NN, et al. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol. 2005;95:13–9.

    Article  PubMed  Google Scholar 

  22. Rihal CS, Textor SC, Grill DE, Berger PB, Ting HH, Best PJ, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2001;105:2259–64.

    Article  Google Scholar 

  23. Spiecker M, Erbel R, Rupprecht HJ, Meyer J. Emergency angioplasty of totally occluded left main coronary artery in acute myocardial infarction and unstable angina pectoris–institutional experience and literature review. Eur Heart J. 1994;15:602–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan

    Sho Hashimoto, Jun Shiraishi, Marie Nishikawa, Takashi Yanagiuchi, Daisuke Ito, Masayoshi Kimura, Eigo Kishita, Yusuke Nakagawa, Masayuki Hyogo, Takatomo Shima, Takahisa Sawada & Yoshio Kohno

  2. Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan

    Takeshi Nakamura, Satoaki Matoba, Hiroyuki Yamada, Akiyoshi Matsumuro & Takeshi Shirayama

  3. Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan

    Makoto Kitamura

  4. Department of Cardiology, Tanabe Central Hospital, Kyotanabe, Japan

    Keizo Furukawa

Authors
  1. Sho Hashimoto
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  2. Jun Shiraishi
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  3. Takeshi Nakamura
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  4. Marie Nishikawa
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  5. Takashi Yanagiuchi
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  6. Daisuke Ito
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  7. Masayoshi Kimura
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  8. Eigo Kishita
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  9. Yusuke Nakagawa
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  10. Masayuki Hyogo
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  11. Takatomo Shima
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  12. Takahisa Sawada
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  13. Satoaki Matoba
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  14. Hiroyuki Yamada
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  15. Akiyoshi Matsumuro
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  16. Takeshi Shirayama
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  17. Makoto Kitamura
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  18. Yoshio Kohno
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  19. Keizo Furukawa
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Corresponding author

Correspondence to Jun Shiraishi.

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The authors have no conflicts of interest regarding the content of the manuscript.

Additional information

On behalf of the AMI-Kyoto Multi-Center Risk Study Group.

Appendix

Appendix

The following institutions and principal investigators participated in the present study: AMI-Kyoto Multi-Center Risk Study Group: Kyoto City Hospital: Okada T, Shima M, Kiyama M, Takamiya A, Nakajima N, Matsunaga S; Kyoto Kidugawa Hospital: Miyanaga H, Nakagawa T, Matsui H, Kunieda Y; Kyoto Second Red Cross Hospital: Fujita H, Inoue K, Matsuo A, Kimura S, Sakatani T, Isodono K, Tsubakimoto Y; Social Insurance Kyoto Hospital: Yamada C, Tanabe S; Tanabe Central Hospital: Kusuoka S, Nishio M, Nishizawa S; Nantan General Hospital: Tatsumi T, Keira N, Nomura T; Ayabe Municipal Hospital: Shiga K, Kohno Y, Adachi Y; Maizuru Medical Center: Harada Y, Hikosaka T; Kyoto Saiseikai Hospital: Ishibashi K; Kouseikai Takeda Hospital: Matsumoto K, Kinoshita N, Sawanishi T, Nakamura R; Kameoka Municipal Hospital: Fukui K; Aiseikai Yamashina Hospital: Kosugi Y, Nakahara Y; Fukuchiyama Municipal Hospital: Sakamoto T; Yamashiro Public Hospital: Tomiyasu K; Saiseikai Shiga Hospital: Nakamura T, Kurata H, Hadase M; Omihachiman Community Medical Center: Maki K, Tatsukawa H, Zen K, Nakagami T, Yokoi H; Kyoto Prefectural Yosanoumi Hospital: Takata H; Kyoto Prefectural University School of Medicine: Shiraishi H, Yamano T.

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Hashimoto, S., Shiraishi, J., Nakamura, T. et al. Survivors of acute myocardial infarction at left main trunk undergoing primary percutaneous coronary intervention. Cardiovasc Interv and Ther 31, 89–95 (2016). https://doi.org/10.1007/s12928-015-0352-2

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  • DOI: https://doi.org/10.1007/s12928-015-0352-2

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