Catheter-based reperfusion of unprotected left main stenosis during an acute myocardial infarction (the ULTIMA experience)

The ULTIMA registry was a prospective, multicenter, international registry of 277 patients who underwent percutaneous coronary interventions of unprot ected left main trunk stenosis. The 40 patients who underwent an emergency percutaneous left main intervention for acute myocardial infarction are the focus of this study. We compared the results of primary angioplasty with p rimary stenting, characterizing both the short-term (in-hospital) and long- term (12-month) outcomes. Of the 40 patients, 23 underwent primary angiopla sty, whereas 17 underwent primary stenting. The angiographic success rate w as an 88% for the cohort. The in-hospital death or coronary artery bypass g rafting rate was 65% for the entire group, 74% for the percutaneous translu minal coronary angioplasty group (PTCA), and 53% for the stent group (p = 0 .2). The in-hospital death rate was 55% for the entire cohort, 70% for the PTCA group, and 35% for the stent group (p = 0.1). The 12-month rate of dea th or bypass surgery was 83% and 58% for the PTCA and stent groups, respect ively (p = 0.047). The 12-month survival rate was 35% and 53% for the PTCA and stent groups, respectively (p = 0.18). Bypass surgery was required in 6 patients in the PTCA group and 2 patients in the stent group (p = 0.07). P atients undergoing percutaneous interventions for unprotected left main myo cardial stenosis during an acute myocardial infarction are critically ill; an initial percutaneous revascularization approach appears feasible and may be the preferred revascularization strategy. Primary stenting was associat ed with improved clinical outcomes. (C) 1999 by Excerpta Medica, Inc.