Twelve-Year Trends in Unprotected Left Main Coronary Artery Occlusion: Insights from a Real-World Multicentre Study
Authors' conclusion
In our real-world population, despite the progressive use of newer drugs and more advanced devices over time, patients with unprotected LMCA occlusion/subtotal occlusion remain a subpopulation with poor prognosis.
Study context
- Population
- Patients with acute myocardial infarction (AMI) from unprotected left main coronary artery (LMCA) occlusion/subtotal occlusion, 2008–2020
- Participants
- 128 patients
- Exposure
- Contemporary vs past period
- Contemporaryn = 77
- Pastn = 51reference
- Outcome
- All-cause mortality (survival analysis)
- Follow-up
- Long-term
Methodological detailsmulticentre, 3 tertiary hospitals
- Multicentre
- 3 tertiary hospitals
Main finding
As reported in the abstract
- Long-term survival rate ≈30%
- Contemporary vs Past: P = 0.599
Observational data: associations, not effects.
Further findings
Hypertension (baseline)
- Past vs contemporary
- 49% vs. 74%; P = 0.005
- Other baseline risk factors did not differ significantly
Chest pain
- Past vs contemporary; more frequent in past
- 98% vs. 89%; P = 0.014
Cardiac arrest
- Past vs contemporary; trend towards more in contemporary
- 18% vs. 31%; P = 0.087
Revascularization type
- No significant difference
- P = 0.419
Manual thrombectomy
- Past vs contemporary; less used in contemporary
- 41% vs. 23%; P = 0.032
Stent implantation
- Past vs contemporary; trend towards higher in contemporary
- 66% vs. 78%; P = 0.150
- Gradual shift from bare-metal to drug-eluting stents
Ticagrelor/prasugrel loading
- Past vs contemporary; higher in contemporary
- 5% vs. 79%; P < 0.001
Mechanical circulatory support use
- Past vs contemporary; higher in past, not significant
- 67% vs. 51%; P = 0.073
Type of mechanical circulatory support (MCS)
- Intra-aortic balloon pump, decrease over time
- 67% vs. 42%; P = 0.005
- VA-ECMO, increase over time
- 4% vs. 22%; P = 0.005
- Impella, increase over time
- 0% vs. 3%
- Type of MCS differed significantly between groups
Original publication
Twelve-Year Trends in Unprotected Left Main Coronary Artery Occlusion: Insights from a Real-World Multicentre Study. ESC Heart Fail. Published 28 March 2024. doi:10.
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