A-8 | When Arteries Fracture Without A Cause: A Case of Multivessel Spontaneous Coronary Artery Dissection (SCAD) and Associated Extra Coronary Arterial Vascular Dissections in the Absence of Connective Tissue Disease

Background: The optimal revascularization strategy for ST-elevation myocardial infarction (STEMI) patients with culprit left main stem coronary artery disease remains controversial.This study compares 30-day clinical outcomes between CABG and PCI in this high-risk population.Methods: Using the TriNetX global federated health research network, we identified 2,438 propensity-matched patients (1,219 in each group) with STEMI and left main stem as culprit vessel who underwent either CABG or PCI.Patient characteristics were well-balanced after propensity matching.The primary outcome was 30-day all-cause mortality.Secondary outcomes included major cardiovascular and cerebrovascular events.Results: At 30 days, CABG was associated with lower all-cause mortality compared to PCI (4.8% vs 8.0%, p0.002).CABG group also demonstrated lower rates of cardiac arrest (3.0% vs 8.4%, p<0.001), heart failure (34.5% vs 40.2%, p0.004), acute kidney injury (15.3% vs 18.9%, p0.018), and cerebral infarction (3.6% vs 7.1%, p<0.001).However, recurrent MI was significantly higher in the CABG group (73.3% vs 87.0%, p<0.001).There were no significant differences in rates of cardiogenic shock, atrial fibrillation, ventricular tachycardia, need for permanent pacemaker, sepsis, GI bleeding, intracranial hemorrhage, and limb ischemia between the two groups.Conclusions: In STEMI patients with culprit left main stem disease, CABG was associated with lower 30-day mortality and fewer cardiovascular complications compared to PCI.CABG might be the preferred revascularization strategy in this high-risk population when feasible.