{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:58:55Z","timestamp":1788857935458,"version":"build-2803163510"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2020,7,27]],"date-time":"2020-07-27T00:00:00Z","timestamp":1595808000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Interventional Cardiology"],"published-print":{"date-parts":[[2020,7,27]]},"abstract":"<jats:p><jats:italic>Objectives<\/jats:italic>. 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. <jats:italic>Background<\/jats:italic>. 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. <jats:italic>Methods<\/jats:italic>. 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). <jats:italic>Results<\/jats:italic>. 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\u20130.36), <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mi>p<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn>0.001<\/mml:mn><\/mml:math>). <jats:italic>Conclusions<\/jats:italic>. 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.<\/jats:p>","DOI":"10.1155\/2020\/5246504","type":"journal-article","created":{"date-parts":[[2020,7,27]],"date-time":"2020-07-27T23:35:13Z","timestamp":1595892913000},"page":"1-8","source":"Crossref","is-referenced-by-count":13,"title":["Primary Angioplasty in a Catastrophic Presentation: Acute Left Main Coronary Total Occlusion\u2014The ATOLMA Registry"],"prefix":"10.1155","volume":"2020","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1445-0478","authenticated-orcid":true,"given":"A.","family":"Guti\u00e9rrez-Barrios","sequence":"first","affiliation":[{"name":"Departamento de Cardiolog\u00eda Hospital Universitario Puerta del Mar, C\u00e1diz, Spain"},{"name":"Instituto de Investigaci\u00f3n e Innovaci\u00f3n en Ciencias Biom\u00e9dicas de C\u00e1diz, INiBICA, C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Gheorghe","sequence":"additional","affiliation":[{"name":"Departamento de Cardiolog\u00eda Hospital Universitario Puerta del Mar, C\u00e1diz, Spain"},{"name":"Instituto de Investigaci\u00f3n e Innovaci\u00f3n en Ciencias Biom\u00e9dicas de C\u00e1diz, INiBICA, C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Camacho-Freire","sequence":"additional","affiliation":[{"name":"Departamento de Cardiolog\u00eda Hospital Juan Ram\u00f3n Jim\u00e9nez, Huelva, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Valencia-Serrano","sequence":"additional","affiliation":[{"name":"Departamento de Cardiolog\u00eda Hospital Torrec\u00e1rdenas, Almer\u00eda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Ca\u00f1adas-Prua\u00f1o","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n e Innovaci\u00f3n en Ciencias Biom\u00e9dicas de C\u00e1diz, INiBICA, C\u00e1diz, Spain"},{"name":"Departamento de Cardiolog\u00eda Hospital de Jerez, C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Calle-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Departamento de Cardiolog\u00eda Hospital Universitario Puerta del Mar, C\u00e1diz, Spain"},{"name":"Instituto de Investigaci\u00f3n e Innovaci\u00f3n en Ciencias Biom\u00e9dicas de C\u00e1diz, INiBICA, C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Alarc\u00f3n de la Lastra","sequence":"additional","affiliation":[{"name":"Departamento de Cardiolog\u00eda Hospital Universitario Puerta del Mar, C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Silva","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n e Innovaci\u00f3n en Ciencias Biom\u00e9dicas de C\u00e1diz, INiBICA, C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Garc\u00eda-Molinero","sequence":"additional","affiliation":[{"name":"Departamento de Cardiolog\u00eda Hospital Universitario Puerta del Mar, C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Agarrado-Luna","sequence":"additional","affiliation":[{"name":"Departamento de Cardiolog\u00eda Hospital de Jerez, C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Zayas-Ruedas","sequence":"additional","affiliation":[{"name":"Departamento de Cardiolog\u00eda Hospital Universitario Puerta del Mar, C\u00e1diz, Spain"},{"name":"Instituto de Investigaci\u00f3n e Innovaci\u00f3n en Ciencias Biom\u00e9dicas de C\u00e1diz, INiBICA, C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"V\u00e1zquez-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Departamento de Cardiolog\u00eda Hospital Universitario Puerta del Mar, C\u00e1diz, Spain"},{"name":"Instituto de Investigaci\u00f3n e Innovaci\u00f3n en Ciencias Biom\u00e9dicas de C\u00e1diz, INiBICA, C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Serra","sequence":"additional","affiliation":[{"name":"Departamento de Cardiolog\u00eda Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"issue":"19","key":"1","doi-asserted-by":"crossref","first-page":"1820","DOI":"10.1056\/NEJMoa1909406","volume":"381","year":"2019","journal-title":"The New England Journal of Medicine"},{"issue":"10219","key":"2","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/S0140-6736(19)32972-1","volume":"395","year":"2020","journal-title":"Lancet"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2010.06.005"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960140217"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a060555"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9149(02)03115-6"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1016\/s1885-5857(09)73326-2"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.4103\/0366-6999.233948"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2016.10.038"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1111\/joic.12466"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1378\/chest.120.4.1212"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.80.5.1166"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.106.685313"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.5114\/aic.2018.78325"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(84)90612-x"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2014.04.011"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.21886"},{"key":"18","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/8238972"},{"key":"19","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2008.03.019"},{"issue":"5","key":"20","first-page":"II65","volume":"88","year":"1993","journal-title":"Circulation"},{"key":"21","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(82)90222-3"},{"key":"22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2003.07.034"},{"key":"23","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9149(99)00139-3"},{"key":"24","doi-asserted-by":"publisher","DOI":"10.1016\/s0300-8932(04)77235-8"},{"key":"25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2007.03.131"},{"key":"26","doi-asserted-by":"publisher","DOI":"10.1097\/mca.0000000000000647"},{"key":"27","doi-asserted-by":"publisher","DOI":"10.1016\/j.recesp.2016.07.019"},{"key":"28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2015.10.016"},{"key":"29","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2013-304435"},{"key":"30","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.1810050308"},{"key":"31","doi-asserted-by":"publisher","DOI":"10.1016\/j.rec.2015.04.010"},{"key":"32","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-008-0735-9"},{"key":"33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.07.012"},{"key":"34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.01.041"}],"container-title":["Journal of Interventional Cardiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/jitc\/2020\/5246504.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/jitc\/2020\/5246504.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/jitc\/2020\/5246504.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,7,27]],"date-time":"2020-07-27T23:35:16Z","timestamp":1595892916000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.hindawi.com\/journals\/jitc\/2020\/5246504\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,27]]},"references-count":34,"alternative-id":["5246504","5246504"],"URL":"https:\/\/doi.org\/10.1155\/2020\/5246504","relation":{},"ISSN":["0896-4327","1540-8183"],"issn-type":[{"value":"0896-4327","type":"print"},{"value":"1540-8183","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,27]]}}}