ABSTRACT
Objective To explore the clinical features of acute myocardial infarction(AMI) caused by left main coronary artery(LMCA)sudden total occlusion and to investigate the clinical efficacy of percutaneous coronary intervention(PCI). Methods A retrospective analysis was carried out and patients with AMI due to LMCA sudden occlusion proved by emergency coronary angiography in General Hospital of DaQing Oil Field between 2000 and 2016 were included. The patients were divided into the survival group and the deceased group. The clinical condition during hospitalization were compared. All in survived cases were followed up by telephone or at out-patient clinic. Results Among 1281 emergency coronary angiography cases,15 patients were proved to have LMCA sudden occlusion and 13 of them received PCI. 6 patients died during hospitalization and the in-hospital mortality rate was 46.2％(6/13). Among the 9 patients who received direct PCI ,5 of them died(55.6％);while 4 patients had elective PCI ,1 patient of them died(25％). Three out of the 4 patients who presented TIMI grade 3 flow died. Among the 9 patients who had TIMI grade 1～2 flow,3 patients died. Eight patients received deal anti-platelet therapy with clopidogrel and aspirin after PCI,and among them,4 patients died. Among the 5 given ticagrelor,2 patients died. During the follow-up period. 1 patient died of cardiogenic shock,2 patients had recurrent angina and 1 patient required elective PCI to the RCA. Conclusions The morality of LMCA sudden total occlusion was significantly high. Successful PCI may be feasible to these patients,while the major adverse cardiovascular events(MACE)occurrence during long-term follow-up period remained high.
ABSTRACT
BACKGROUND: Identification of acute coronary lesions amenable to urgent intervention in survivors of out-of-hospital cardiac arrest is crucial. We aimed to compare the clinical and electrocardiographic characteristics to urgent coronary findings, and to analyze in-hospital prognosis of these patients. METHODS: From January 2005 to December 2012 we retrospectively identified consecutive patients resuscitated from out-of-hospital cardiac arrest, and analyzed the clinical characteristics, post-resuscitation electrocardiogram and coronary angiogram of those who underwent emergent angiography. Mortality and neurologic status at discharge were also assessed. RESULTS: Patients with ST-elevation more frequently had obstructive coronary artery disease (89% vs. 51%, p<0.001) or acute coronary occlusions (83% vs. 8%, p<0.001) than patients without ST-elevation. Independent predictors of an acute coronary occlusion were chest pain before arrest (OR 0.16, 95% CI 0.04-0.7, p=0.01), a shockable initial rhythm (OR 0.16, 95% CI 0.03-0.9, p=0.03), and ST-elevation on the post-resuscitation electrocardiogram (OR 0.02, 95% CI 0.004-0.13, p<0.001). Survival with favorable neurologic recovery at discharge was 59%. Independent predictors of mortality or unfavorable neurological outcome at discharge were absence of basic life support (OR 0.2, 95% CI 0.06-0.9, p=0.04), prolonged resuscitation time (OR 0.9, 95% CI 0.8-0.9, p=0.01), and necessity of vasopressors (OR 14.8, 95% CI 3.3-65.4, p=0.001). CONCLUSIONS: Most patients with ST-elevation on the post-resuscitation electrocardiogram had an acute coronary occlusion, as opposed to patients without ST-elevation. Absence of basic life support, prolonged resuscitation time and use of vasopressors were independent predictors of worse in-hospital outcome.