Clinical Features, Prognosis and Lessons Among Patients With Acute Total Occlusion of the Left Main Coronary Artery, Never Too Later to Learn
Zhong Chen1, Yanrong Zhu, Wei Hu2, Lei Chen3, Liansheng Wang4, Xian Jin
Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, China1, Minhang Hospital, Fudan University, China2, The Affiliated Hospital of Xuzhou Medical University, China3, The First Affiliated Hospital of Nanjing Medical University, China4
Survival from acute total occlusion ofleft main coronary artery (LMCA) is difficult. It’s never too later to learnfrom these tragedies. This study aims to investigate the clinical features ofpatients with acute LMCA occlusion, tries to determine the predictors ofin-hospital mortality and long-term outcomes for clinical reference.
Thirty patients suffering from acute total occlusion of LMCA were enrolled. Available main anthropometric parameters including history of hypertension, diabetes, dyslipidemia, smoking status, total ischemia duration, time of door to balloon (DTB), coronary angiography (CAG) findings, coronary collateral circulation, plasma levels of blood sugar, main lipids parameters, renal function, cTnI/T, pro-BNP, UCG parameters, in-hospital, one- and three-year outcomes were collected and analyzed.
Twenty-nine patients underwent urgent percutaneous coronary intervention (PCI) and mean time from onset to hospital is 7.6±6.5 hours. 9 died in hospital and 21 cases discharged and the mean DTB time was comparable between these two groups. Cardiogenic shock was present in 23.3% of patients before CAG and 56.6% after PCI. During hospitalization, a total of 88.9% (8/9) patients in the in-hospital mortality group presented TIMI Ⅲ or Ⅳ grade flow (TIMI 3/4 flow), which was significantly higher in the survival and discharge group (88.9% vs. 38.1%, P=0.011). Multivariate analysis showed that usage of intra-aortic balloon pump (IABP) (P=0.048) and final TIMI 3/4 flow (P=0.03) were the predictors of in-hospital mortality. With regards to one- and three-year all-cause mortality, however, use of IABP did not reduce 12-month and 36-month mortality. While final TIMI 3/4 flow after emergency PCI presented better 36-month survival (P=0.035).
The present study showed that patients with acute total occlusion of LMCA are facing higher in-hospital mortality and poor long-term prognosis. Use of IABP and final TIMI 3/4 flow after urgent PCI were convenient predictors of in-hospital mortality. Only final TIMI 3/4 flow after PCI is the independent predictor of long-term outcomes. Active primary prevention and timely medical contact and treatment could delay the onset of cardiac attack and save more lives. (ChiCTR-DDD-17013908)