Primary Angioplasty in a Catastrophic Presentation : Acute Left Main Coronary Total Occlusion - The ATOLMA Registry
Gutierrez-Barrios, A. (Instituto de Investigacion e Innovacion en Ciencias Biomedicas de Cadiz)
Gheorghe, L. (Instituto de Investigacion e Innovacion en Ciencias Biomedicas de Cadiz)
Camacho-Freire, S. (Hospital Juan Ramón Jiménez (Huelva))
Valencia-Serrano, F. (Hospital Torrecárdenas)
Canadas-Pruano, D. (Hospital de Jerez)
Calle Pérez, Germán (Instituto de Investigacion e Innovacion en Ciencias Biomedicas de Cadiz)
Alarcon De La Lastra, I. (Hospital Universitario Puerta del Mar (Cadis, Andalusia))
Silva, E. (Instituto de Investigacion e Innovacion en Ciencias Biomedicas de Cadiz)
Garcia-Molinero, D. (Hospital Universitario Puerta del Mar (Cadis, Andalusia))
Agarrado-Luna, A. (Hospital de Jerez)
Zayas-Ruedas, R. (Instituto de Investigacion e Innovacion en Ciencias Biomedicas de Cadiz)
Vazquez-Garcia, R. (Instituto de Investigacion e Innovacion en Ciencias Biomedicas de Cadiz)
Serra, Antonio (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Data:	2020
Resum:	To determine the outcome predictors of in-hospital mortality in acute total occlusion of the left main coronary artery (ATOLMA) patients referred to emergent angioplasty and to describe the clinical presentation and the long-term outcome of these patients. ATOLMA is an uncommon angiographic finding that usually leads to a catastrophic presentation. Limited and inconsistent data have been previously reported regarding true ATOLMA, yet comprehensive knowledge remains scarce. This is a multicenter retrospective cohort that includes patients presenting with myocardial infarction due to a confirmed ATOLMA who underwent emergency percutaneous coronary intervention (PCI). In the period of the study, 7930 emergent PCI were performed in the five participating centers, and 46 of them had a true ATOLMA (0. 58%). At admission, cardiogenic shock was present in 89% of patients, and cardiopulmonary resuscitation was required in 67. 4%. All the patients had right dominance. Angiographic success was achieved in 80. 4% of the procedures, 13 patients (28. 2%) died during the catheterization, and the in-hospital mortality rate was 58. 6% (27/46). At one-year and at the final follow-up, 18 patients (39%) were alive, including four cases successfully transplanted. Multivariate analysis showed that postprocedural TIMI flow was the only independent predictor of in-hospital mortality (OR 0. 23, (95% CI 0. 1-0. 36), p<0. 001). Our study confirms that the clinical presentation of ATOLMA is catastrophic, presenting a high in-hospital mortality rate; nevertheless, primary angioplasty in this setting is feasible. Postprocedural TIMI flow resulted as the only independent predictor of in-hospital mortality. In-hospital survivors presented an encouraging outcome. ATOLMA and left dominance could be incompatible with life.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Journal of Interventional Cardiology, Vol. 2020 (2020) , p. 5246504, ISSN 1540-8183

DOI: 10.1155/2020/5246504
PMID: 32774186

8 p, 2.2 MB

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