Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Outcomes in Patients with ACS Due to LMCAD

Am Heart J; ePub 2018 Feb 22; Gharacholou, et al

While unprotected culprit left main coronary artery disease (LMCAD) acute coronary syndrome (ACS) necessitating percutaneous coronary intervention (PCI) is uncommon, it is associated with reduced survival after long-term follow-up. This according to a study that included 8,794 patients hospitalized with unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) or ST-elevation myocardial infarction (STEMI) treated with PCI. Of this group, 83 (0.94%) patients were identified as having culprit LMCAD ACS. Researchers found:

  • 40 patients presented with STEMI and 43 patients presented with UA/STEMI.
  • LM STEMI patients were younger and had less hypertension compared to LM UA/NSTEMI, with a trend towards greater frequency of cardiogenic shock.
  • In-hospital mortality was 33% in LM STEMI vs 9% in LM UA/STEMI.
  • Over a median follow-up of 6.3 years, long-term survival rates in both groups were similar.


Gharacholou SM, Ijioma NN, Lennon RJ, et al. Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention. [Published online ahead of print February 22, 2018]. Am Heart J. doi:10.1016/j.ahj.2018.02.012.

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