Primary angioplasty in ST-elevation myocardial infarction due to unprotected left-main coronary disease in a high-volume catheterization center without on-site surgery facilities: immediate and medium-term outcome: the STEMI-Placet Registry.

BACKGROUND: Very few data have been published for ST-elevation myocardial infarction (STEMI) caused by unprotected left main coronary artery (ULMCA) and very little is known about the results in this subgroup of patients in a hospital with high-volume catheterization laboratories (cath labs) without on-site cardiosurgery.

METHODS AND RESULTS: From January 2004 to December 2009, a total of 38 patients with evolving STEMI and ULMCA as the culprit lesion treated with primary angioplasty were enrolled in our registry. Despite dramatic clinical presentation (73.7% cardiogenic shock, 15.8% cardiac arrest and resuscitation maneuvers, 81.6% additive EuroSCORE >13, and 89.5% distal bifurcation involvement), angiographic success was obtained in 84.2% and final TIMI 3 flow was achieved in 34 (89.5%), while target lesion failure occurred in 47.4% (mostly [42.1%] during the in-hospital phase). Most of the patients discharged from hospital had no events at follow-up (47.4%), and notably no target lesion revascularization was required during the follow-up phase.

CONCLUSIONS: Primary angioplasty in patients presenting with ULMCA as the culprit lesion in a STEMI setting appears to be technically feasible and a good alternative to surgical revascularization. Mortality in this group of patients tends to be high, but lower than mortality of untreated patients; the majority of events are concentrated during the in-hospital phase. Procedural delay related to activation of operator's staff in off-duty hours doesn't correlate with a worse prognosis.