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KMID : 0882420040670030249
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Korean Journal of Medicine
2004 Volume.67 No. 3 p.249 ~ p.254
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Early and late clinical outcomes after primary stenting of the unprotected left main coronary artery stenosis in the setting of ac
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Yi Myung-Zoon
Lee Seung-Whan
Lee Se-Hwan
Park Chang-Bum
Kim Sung-Du
Han Song-Yi
Kim Young-Hak
Lee Cheol-Whan
Hong Myeong-Ki
Kim Jae-Joong
Park Seong-Wook
Park Seung-Jung
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Abstract
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Background: Acute left main coronary artery occlusion is a dramatic condition with very high mortality. The study was aimed to evaluate the effect of primary stenting in patients with left main coronary artery disease in the setting of acute myocardial infarction.
Methods: Between June 1997 and April 2002, primary stenting for left main coronary artery disease was performed in eighteen patients with acute myocardial infarction. We evaluated clinical outcomes and prognostic determinants in this clinical setting.
Results: Mean ages of patients were 59 +/- 12 years. Fourteen patients had cardiogenic shock on admission. Angiographic success (TIMI flow >or= 2 and diameter stenosis < 30% after stenting) was achieved in 17 patients (94%). In-hospital death occurred in 8 patients (44%). Two patients (11%) received emergent bypass surgery because of hemodynamic instability after primary stenting. On univariate analysis, good pre-intervention TIMI flow (grade >or= 2) was identified as a good prognostic determinant of in-hospital survival. During mean follow-up of 39 +/- 22 months, there was no late death and 1 patient received bypass surgery. Probability of freedom from death at 3-year was 56 +/- 12%.
Conclusion: Primary stenting is a valuable therapeutic strategy for left main coronary disease in the setting of acute myocardial infarction, and it might save the life especially in patients with good pre-intervention TIMI flow (grade >or= 2). Long-term clinical outcome of patients surviving to hospital discharge is favorable.
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KEYWORD
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Stent, Acute myocardial infarction, Coronary arteriosclerosis
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