Clinical profile and 1-year mortality predictors in left main coronary artery percutaneous coronary intervention for acute myocardial infarction
T Carlos, G Batista, L Rocha, B Resende, M Grine, L Leite, L GoncalvesAbstract
Background
Acute myocardial infarction (AMI) due to left main coronary artery (LMCA) obstruction represents a rare yet severe condition, characterized by elevated in-hospital morbidity and mortality rates.
Purpose
Evaluate baseline and demographic characteristics of patients undergoing percutaneous coronary interventions in this scenario, compare them based on their global 1-year outcome and identify potential predictors of survival.
Methods
A single-centre retrospective observational study assessed consecutive patients who underwent LMCA-PCI for both ST-elevation and non-ST-elevation myocardial infarction, from January 2020 to December 2022. Elective interventions and patients with insufficient data or lost follow-up were excluded. We assessed their baseline characteristics and their global mortality rates at 30, 90 and 180 days, and 1 year. Survivors and non-survivors within 1 year were compared using parametric/non-parametric and chi-square/Fisher tests. Lastly, we performed Cox regression to identify possible predictors of survival.
Results
A cohort of 59 patients with a mean age of 69.6 ± 11.8 years and a male predominance (76%), was enrolled in the study. The prevailing comorbidity was hypertension (68%), followed by dyslipidemia (64%). ST-elevation myocardial infarction (STEMI) was the most prevalent clinical presentation (59%). The all-cause mortality rate at 30 days was 24%, increasing to 34% at 1-year follow-up (20 patients). In the comparative analysis between survivors and non-survivors after 1 year of follow-up, advanced age (p=0.019) and elevated levels of high-sensitivity troponin I (hsTNI) at admission (p=0.011) exhibited significant associations with mortality. No statistically significant differences were observed regarding hypertension, gender, smoking, diabetes, or clinical presentation. Cox regression analysis suggested hsTNI peak value in the first 72 hours as a potential predictor of survival, notwithstanding its modest hazard ratio (p<0.001, HR 1.000003).
Conclusions
Acute LMCA-PCI in our centre primarily addresses STEMI, reflecting its severity on initial presentation and mainly justifying higher short-term mortality. Older age and elevated admission hsTNI levels were associated with 1-year mortality, with peak hsTNI in the first 72 hours potentially predicting survival, despite its low hazard ratio.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.