Original title: A Systematic Review and Meta-Analysis on Primary Percutaneous Coronary Intervention on an Unprotected Left Main Coronary Artery Culprit Lesion in the setting of Acute Myocardial Infarction Reference: Marije M. Vis et al. J Am Coll Cardiol Intv 2013;6:317–24

Acute myocardial infarction with a significantly compromised unprotected left main coronary artery culprit lesion is relatively rare (4% to 7%), but presents high mortality rates. Until now, there are no randomized studies on this issue; this is why the meta analysis included 13 cohort studies on unprotected left main as the infarct-related coronary artery; results were evaluated at 30 days. 

997 patients were analyzed, of which 252 (26%) presented in cardiogenic shock and 6.3% had presented cardiorespiratory arrest before PCI. 30 day mortality rate was 57% in patients presenting cardiogenic shock and 11% in those that were stable (RR: 3.74, 95% IC: 2.95 to 4.76 <0.001). Neither balloon angioplasty or the implantation of conventional or drug eluting stents, alter the results of patients that presented in cardiogenic shock.

Conclusion: 

Patients that received PCI to the unprotected left main, had significantly higher 30 day mortality rate when presenting cardiogenic shock at the moment of admission compared to those who were stable. This result was not related to the kind of stent used.

Editorial Comment: 

Although this is a meta analysis, the study shows the evolution of primary PCI to the left main. There are limited available data on this procedure, which differs from the rest of PCI procedures. The intra aortic counterpulsation balloon has not been proved particularly beneficial, though we are still waiting for the ISAR SHOCK 2 outcomes. Sure enough, left ventricular assist devices such as the Impella, TandemHeart, ECMO, or other newer devices, shall facilitate this procedure and provide more benefits to these patients. 

Courtesy of Dr. Carlos Fava.
Interventional Cardiology,
Favaloro Foundation. Buenos Aires, Argentina

Dr. Carlos Fava para SOLACI.ORG