Acute Myocardial Infarction Clinical Trial
Official title:
Short Term Outcome Of Primary Precutaneous Coronary Intervention In Ostial Versus Non Ostial Culprit Proximal Left Anterior Descending Artery Acute Myocardial Infraction
To compare short-term clinical outcomes of primary PCI between the ostial LAD-AMI and the non-ostial LAD-AMI. The primary endpoint was the major cardiovascular events (MACE) defined as being the composite of cardiac death, AMI, stent thrombosis
Current guidelines recommend percutaneous coronary intervention (PCI) for most patients with
ST segment elevation acute myocardial infarction (STEMI) or with non ST segment elevation
acute coronary syndrome (NSTEACS) (1), (2). In STEMI patients, PCI is advised in all patients
in the first 12 hours after onset of symptoms, the earlier the better (1).
Coronary revascularization does not always lead to coronary reperfusion. The development of
devices and procedure has improved clinical outcomes of percutaneous coronary intervention
(PCI) to the culprit of acute myocardial infarction (AMI) (3-5).
However, proximal left anterior descending artery (LAD)-AMI has still been associated with
high morbidity and mortality because of the broad ischemic area (6, 7). In fact, clinical
outcomes were significantly worse in the proximal LAD-AMI as compared with the mid LAD-AMI.5)
Moreover, the proximal LAD disease in stable angina was closely associated with early
revascularization following optimal medical therapy (8). Therefore, clinical guidelines
regarding coronary revascularization have discriminated the proximal LAD disease from other
LAD diseases (9).
In terms of coronary revascularization, the ostial LAD disease requires special attention in
the proximal LAD disease, because percutaneous coronary interventions (PCI) can be more
complex in the ostial LAD disease than in the non-ostial proximal LAD disease (10) even in
the setting of AMI, left-main-trunk (LMT)-to-LAD crossover stenting was frequently required
in the ostial LAD disease (11).
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