TCT-365 Characteristics and Outcomes of ST-Segment Elevation Myocardial Infarction due to Left Main Coronary Artery Stenosis

Document Type

Conference Proceeding

Publication Date

10-28-2025

Publication Title

J Am Coll Cardiol

Keywords

Cardiovascular System & Cardiology

Abstract

Background: There is limited data on the incidence and outcomes of ST-segment elevation myocardial infarction (STEMI) due to left main coronary artery (LMCA) culprit lesion. Methods: The Nationwide Readmissions Database was utilized to identify hospitalizations with LMCA STEMI between January 2016 and December 2022. The primary outcome was all-cause in-hospital mortality during index admission. Results: Among 1,528,764 weighted hospitalizations with STEMI from 2016 to 2022, 4,885 (0.3%) were due to LMCA lesions, of which 2,156 (44.1%) had cardiogenic shock (CS). The number of LMCA STEMI hospitalizations and the incidence of CS increased over time. Mechanical circulatory support was used in 78.8% of the patients with LMCA STEMI and CS, with intra-aortic balloon pump being the most common modality (63%). Impella utilization increased from 4.5% in Q1 2016 to 34% in Q4 2022. Revascularization was performed in 78.2% of cases, with percutaneous coronary intervention (PCI) being the most common revascularization modality (62.1%). Among those who had PCI, intravascular imaging (IVI) was used in 18.3%, with a significant increase from 9.6% in Q1 2016 to 26.3% in Q4 2022. All-cause in-hospital mortality was 25.5% and was significantly higher among CS patients (43.4% vs. 11.4%, P<0.001). Conclusion: The incidence of LMCA STEMI increased from 2016 to 2022 with nearly half of the patients developing CS. IVI use in LMCA PCI was low (18.3%) but increased over time. More than 1 in 4 patients with LMCA STEMI died during the index hospitalization.

Volume

86

Issue

17

First Page

1

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