title: Determinants of in-hospital death in left main coronary artery myocardial infarction complicated by cardiogenic shock.
abstract: BACKGROUND
  Acute myocardial infarction (AMI) due to left main coronary artery disease is associated with significantly elevated morbidity and mortality. The aim of this study was to identify the predictors of in-hospital death from left main AMI complicated by cardiogenic shock.
  
  
  METHODS
  Clinical record review identified a total of 25 cases of left main AMI with cardiogenic shock. Patients' background characteristics, laboratory data, and angiographic findings were analyzed according to the in-hospital mortality.
  
  
  RESULTS
  In this patient subset, in-hospital mortality (60%) was associated with a history of hypertension (p=0.02) and a higher heart rate (p=0.02). Furthermore, in-hospital mortality was also associated with a complete right bundle branch block (CRBBB) pattern in the admission ECG (p=0.01) and low HCO(3)(-) (p=0.0004). In stepwise logistic regression analysis, a CRBBB pattern (OR 48.59, 95% CI 1.34-1768.10, p=0.03) and low HCO(3)(-) (OR 0.62, 95% CI 0.40-0.94, p=0.02) were found to be independent predictors of mortality.
  
  
  CONCLUSIONS
  Left main AMI with cardiogenic shock was associated with high in-hospital mortality. A CRBBB pattern in the ECG on admission and a low HCO(3)(-) concentration were significant independent predictors of in-hospital death.
authors.affiliation: Division of Cardiovascular Medicine, Department of Integrated Medicine I, Jichi Medical University Saitama Medical Center, Omiya, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sakakura
authors.forename: Norifumi
authors.initials: N
authors.lastname: Kubo
authors.forename: Shigemasa
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Nahoko
authors.initials: N
authors.lastname: Ikeda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Funayama
authors.forename: Taishi
authors.initials: T
authors.lastname: Hirahara
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Takanori
authors.initials: T
authors.lastname: Yasu
authors.forename: Junya
authors.initials: J
authors.lastname: Ako
authors.forename: Masanobu
authors.initials: M
authors.lastname: Kawakami
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Momomura
mesh_terms: D002037:Bundle-Branch Block / Q000150:complications; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000150:complications; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D012044:Regression Analysis; D012770:Shock, Cardiogenic / Q000150:complications*