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Objectives: To determine the outcome predictors of in-hospital mortality in acute total occlusion of the left main coronary artery (ATOLMA) patients referred to emergent angioplasty and to describe the clinical presentation and the long-term outcome of these patients.Background: ATOLMA is an uncommon angiographic finding that usually leads to a catastrophic presentation. Limited and inconsistent data have been previously reported regarding true ATOLMA, yet comprehensive knowledge remains scarce.Methods: This is a multicenter retrospective cohort that includes patients presenting with myocardial infarction due to a confirmed ATOLMA who underwent emergency percutaneous coronary intervention (PCI).Results: In the period of the study, 7930 emergent PCI were performed in the five participating centers, and 46 of them had a true ATOLMA (0.58%). At admission, cardiogenic shock was present in 89% of patients, and cardiopulmonary resuscitation was required in 67.4%. All the patients had right dominance. Angiographic success was achieved in 80.4% of the procedures, 13 patients (28.2%) died during the catheterization, and the in-hospital mortality rate was 58.6% (27/46). At one-year and at the final follow-up, 18 patients (39%) were alive, including four cases successfully transplanted. Multivariate analysis showed that postprocedural TIMI flow was the only independent predictor of in-hospital mortality (OR 0.23, (95% CI 0.1-0.36), p < 0.001).Conclusions: Our study confirms that the clinical presentation of ATOLMA is catastrophic, presenting a high in-hospital mortality rate; nevertheless, primary angioplasty in this setting is feasible. Postprocedural TIMI flow resulted as the only independent predictor of in-hospital mortality. In-hospital survivors presented an encouraging outcome. ATOLMA and left dominance could be incompatible with life. [ABSTRACT FROM AUTHOR]

Objectives and background Patients with aortic stenosis (AS) may have impaired coronary flow reserve (CFR) despite angiographically normal coronary arteries. This is the first report of invasive thermodilution-derived CFR and IMR in patients with AS and their associations with echocardiographic parameters for AS assessment. Methods Thirty-six consecutive severe AS patients and ten patients without AS underwent prospectively cardiac catheterization and coronary physiological parameters were determined in the left anterior descending (LAD). Mean transit time (Tmn), a surrogate of absolute coronary flow, was obtained from the coronary thermodilution curve. Results In AS patients we found a high LAD flow at rest (Tmn rest 0.55 ± 0.3 vs 0.99 ± 0.4, p = 0.01) and a low flow at hyperemia (Tmn hyp 0.44 ± 0.2 vs 27.7 ± 0.1, p = 0.02) and consequently a severe CFR impairment (1.4 ± 0.4 vs 3.8 ± 1.4, p < 0.001) compared with controls. An elevated index of microvascular resistance (IMR) (32.7 ± 16 vs 17.8 ± 6.5, p = 0.01) and a low baseline microvascular coronary resistance (48.1 ± 29 vs 84 ± 34, p = 0.02) were also found. In AS patients there were significant correlations between CFR and left ventricular mass index (r = − 0.32; p = 0.02), and the ratio of acceleration time to ejection time (AT/ET) (r = − 0.4; p = 0.01) a non-flow dependent echocardiographic parameter for AS assessment. Multiple linear stepwise regression analysis showed that AT/ET (β = − 0.441, p = 0.019) was the only independently variable associated with CFR Conclusions In severe AS, invasive CFR shows a progressive decrease with AS severity and a good correlation with echocardiographic parameters of AS, especially with flow-independent ones. [ABSTRACT FROM AUTHOR]