Management of unprotected left main culprit AMI in the present era (2018-2022) was associated with significantly lower 30-day mortality compared to 2013-2017 (18.9% vs. 32.3%, P=0.04).
Observational (n=187)
Yes
Does management in the recent era or at high-volume institutions improve mortality in patients with unprotected left main culprit acute myocardial infarction?
Short-term mortality for unprotected left main culprit AMI has significantly improved over the last decade and is better at high-volume centers, though 2-year prognosis remains unchanged.
Absolute Event Rate: 18.9% vs 32.3%
p-value: p=0.04
Abstract Background Patients with acute myocardial infarction (AMI) caused by an unprotected left main trunk (LMT) often experience cardiopulmonary arrest or cardiogenic shock, and are considered to have a poor prognosis. Although the management of AMI has improved over the years, there are few cases of AMI caused by LMT culprit, and there are many unknowns, such as changes in the number of cases over time, changes in prognosis and characteristics of the disease. In addition, the differences in prognosis between institutions have not been fully investigated. Purpose The purpose of this study was to evaluate the changes in prognosis over the 10-year period and the differences in prognosis between the institutions. Methods From January 2013 to December 2022, 6739 AMI patients were enrolled from the Mie ACS registry after excluding the patients without emergency coronary angiography and patients with a history of coronary artery bypass grafting (CABG). Patients were divided into two groups based on the chronology of presentation: a "past group" (January 2013 to December 2017) and a "present group" (January 2018 to December 2022). In addition, the institutions were divided into two groups based on the institutional volume for the management of AMI with LMT culprit. The study compares clinical characteristics, and short-term prognosis including 30-day mortality and in-hospital mortality between the two groups. Results Among 6739 AMI patients, 187 (2.8%) AMI patients with LMT culprit were observed. There was an increasing trend in the proportion of AMI patients with LMT culprit over the past decade (Figure 1A). Compared to the "past group" with 65 (2.1%) patients, the "present group" with 122 (3.3%) patients showed a higher incidence of AMI with LMT culprit (P＜0.01). Baseline patient characteristics showed no statistically significant differences between the two groups. In addition, there was no significant difference in angiographic findings and management (Table 1). In the survival analysis, the present group showed significantly favorable 30-day mortality compared to the past group (18.9% vs. 32.3％, P=0.04, Figure 1B). In addition, the high-volume institution for AMI with LMT culprit management showed significantly favorable in-hospital mortality compared to the low-volume institution (34.8% vs. 20.0％, P=0.02 Figure 1C). However, the 2-year prognosis was not significantly different between the past group and the present group, and between the low-volume and the high-volume institution. Conclusion With improvements in management over time, the short-term prognosis for LMT culprit AMI is improving. Further advances in treatment may be needed to improve the long-term prognosis.Figure Table
Rakuka et al. (Sat,) conducted a observational in Acute myocardial infarction with unprotected left main trunk culprit (n=187). Present era (2018-2022) management vs. Past era (2013-2017) management was evaluated on 30-day mortality (p=0.04). Management of unprotected left main culprit AMI in the present era (2018-2022) was associated with significantly lower 30-day mortality compared to 2013-2017 (18.9% vs. 32.3%, P=0.04).