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Clinical outcome of unprotected left main coronary artery disease in patients with acute myocardial infarction.

The clinical outcome of patients with acute myocardial infarction (MI) with unprotected left main coronary artery (LMCA) stenosis is not fully understood. We sought to assess the outcomes of patients with acute MI who underwent percutaneous coronary intervention (PCI) for unprotected LMCA stenosis. A total of 587 patients enrolled in the Korea Acute Myocardial Infarction Registry with LMCA stenosis were analyzed. Patients with culprit LMCA had higher inhospital mortality than patients with non-culprit LMCA (16.0% versus 8.9%, P = 0.008), but had similar clinical outcomes during a 12-month follow-up. Compared to CABG, PCI using drug-eluting stents (DES) was more frequently performed with similar early and 12-month clinical outcomes. The efficacy of sirolimus-eluting stents, paclitaxel-eluting stents, and zotarolimus-eluting stents were comparable at 12-month clinical follow-up. Predictors of 12-month mortality included mechanical ventilation, cardiogenic shock, age > 65 years, and ejection fraction < 40%. Patients with acute MI and culprit LMCA have higher early mortality than patients with non-culprit LMCA. PCI with DES is frequently performed and the clinical outcome is similar between the 3 types of first-generation DES.