Prognostic impact of significant non-infarct-related left main coronary artery disease in patients with acute myocardial infarction who receive a culprit-lesion percutaneous coronary intervention

Suk Min Seo, Tae-Hoon Kim, Chan Jun Kim, Byung Hee Hwang, Min Kyu Kang, Yoon Seok Koh, Jinsoo Min, Kiyuk Chang, Pum Joon Kim, Hun Jun Park, Wook Sung Chung, Myung Ho Jeong, Young Jo Kim, Seung Jung Park, Ki-Bae Seung
Coronary Artery Disease 2012, 23 (5): 307-14

BACKGROUND: Infarct-related left main coronary artery disease (LMCAD) is associated with an increased cardiac mortality in the setting of acute myocardial infarction (AMI). However, the prevalence and prognostic impact of significant (≥50% stenosis) non-infarct-related LMCAD in patients with AMI have not yet been elucidated.

METHODS: We prospectively analyzed 7655 AMI patients who had undergone a percutaneous coronary intervention (PCI) in the Korea Acute Myocardial Infarction Registry from November 2005 to January 2008. We compared major adverse cardiac events (MACEs) in AMI patients with non-infarct-related LMCAD and those without LMCAD.

RESULTS: Of 99 (1.3%) non-infarct-related LMCAD patients, 40 patients had undergone PCI due to their lesions on the left main coronary artery. The incidences of all-cause death, cardiac death, recurrent myocardial infarction, and composite of MACE except repeat revascularization were higher in patients with non-infarct-related LMCAD at 12 months. In Cox proportional hazard analysis for the prediction of MACE at 12 months, the hazard ratio of LMCAD was 2.189 (95% confidence interval 1.230-3.896, P=0.008). In subgroup analysis, there was no significant cumulative difference between patients who had undergone non-infarct-related left main coronary artery PCI and those who did not undergo PCI at 1 and 12 months.

CONCLUSION: The significant, non-infarct-related LMCAD in patients with AMI remains a major adverse prognostic indicator even after receiving optimal culprit-lesion PCI.

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