Catheter-based reperfusion of unprotected left main stenosis during an acute myocardial infarction (the ULTIMA experience)

Catheter-based reperfusion of unprotected left main stenosis during an acute myocardial infarction (the ULTIMA experience)

The ULTIMA registry was a prospective, multicenter, international registry of 277 patients who underwent percutaneous coronary interventions of unprotected left main trunk stenosis. The 40 patients who underwent an emergency percutaneous left main intervention for acute myocardial infarction are the...

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Bibliographic Details
Published in:The American journal of cardiology Vol. 83; no. 11; pp. 1513 - 1517
Main Authors: Marso, Steven P, Steg, Gabriel, Plokker, Thijs, Holmes, David, Park, Seung-Jung, Kosuga, Kunihiko, Tamai, Hideo, Macaya, Carlos, Moses, Jeffery, White, Harvey, Verstraete, S.F.C, Ellis, Stephen G
Format: Journal Article
Language:English
Published: New York, NY Elsevier Inc 01-06-1999
Elsevier
Elsevier Limited
Subjects:
Biological and medical sciences
Cardiology
Diseases of the cardiovascular system
Heart attacks
Medical research
Medical sciences
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Short term
Human
Endoprosthesis
Prognosis
Infarct
Treatment efficiency
Instrumentation therapy
Cuffed tube
Stenosis
Cardiovascular disease
Left coronary artery
Instrumental dilatation
Coronary heart disease
Myocardial disease
Long term
Stent
Arterial disease
Vascular disease
Treatment
Myocardium
Evolution
Comparative study
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Summary:The ULTIMA registry was a prospective, multicenter, international registry of 277 patients who underwent percutaneous coronary interventions of unprotected left main trunk stenosis. The 40 patients who underwent an emergency percutaneous left main intervention for acute myocardial infarction are the focus of this study. We compared the results of primary angioplasty with primary stenting, characterizing both the short-term (in-hospital) and long-term (12-month) outcomes. Of the 40 patients, 23 underwent primary angioplasty, whereas 17 underwent primary stenting. The angiographic success rate was an 88% for the cohort. The in-hospital death or coronary artery bypass grafting rate was 65% for the entire group, 74% for the percutaneous transluminal coronary angioplasty group (PTCA), and 53% for the stent group (p = 0.2). The in-hospital death rate was 55% for the entire cohort, 70% for the PTCA group, and 35% for the stent group (p = 0.1). The 12-month rate of death or bypass surgery was 83% and 58% for the PTCA and stent groups, respectively (p = 0.047). The 12-month survival rate was 35% and 53% for the PTCA and stent groups, respectively (p = 0.18). Bypass surgery was required in 6 patients in the PTCA group and 2 patients in the stent group (p = 0.07). Patients undergoing percutaneous interventions for unprotected left main myocardial stenosis during an acute myocardial infarction are critically ill; an initial percutaneous revascularization approach appears feasible and may be the preferred revascularization strategy. Primary stenting was associated with improved clinical outcomes.
ISSN:0002-9149
1879-1913
DOI:10.1016/S0002-9149(99)00139-3