Gagnor Andrea, Tomassini Francesco, Romagnoli Enrico, Montali Nicolò, Giolitto Sara, Tizzani Emanuele, Infantino Vincenzo, Varbella Ferdinando
Ospedale degli Infermi, ASL TO 3, Cardiology Department, Rivoli (Turin), Italy.
J Invasive Cardiol. 2012 Dec;24(12):645-9.
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.
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.
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.
关于无保护左主干冠状动脉（ULMCA）导致的ST段抬高型心肌梗死（STEMI）的数据极少公布，对于在没有现场心脏外科手术的高容量导管实验室（导管室）的该亚组患者的治疗结果知之甚少。
从2004年1月至2009年12月，共有38例以ULMCA为罪犯病变的进展期STEMI患者接受了直接血管成形术并纳入我们的登记研究。尽管临床表现严重（73.7%发生心源性休克，15.8%发生心脏骤停及复苏操作，81.6%的相加欧洲心脏手术风险评估系统（EuroSCORE）>13，89.5%存在远端分叉病变），但血管造影成功率为84.2%，34例（89.5%）实现了最终TIMI 3级血流，而靶病变失败发生率为47.4%（大多数[42.1%]发生在住院期间）。大多数出院患者在随访期间无事件发生（47.4%），值得注意的是，随访期间无需进行靶病变血运重建。
对于以ULMCA为STEMI罪犯病变的患者，直接血管成形术在技术上似乎可行，是外科血运重建的良好替代方案。该组患者死亡率往往较高，但低于未治疗患者的死亡率；大多数事件集中在住院期间。与非工作时间启动操作人员相关的手术延迟与预后较差无关。
