Clinical presentation and prognostic factors of patients with acute ST-segment elevation myocardial infarction following emergent revascularization for left main coronary artery obstruction.
BACKGROUND
Acute ST-segment elevation myocardial infarction (STEMI) caused by left main coronary artery (LMCA) obstruction is uncommon. Although the link between this catastrophic disease and very high mortality is well recognized, even after undergoing emergent revascularization, the systemic risk stratification and long-term outcome are currently unclear. The clinical presentation, parameter-related in-hospital death and long-term outcomes of these patients with acute LMCA obstruction undergoing emergency revascularization were carefully reviewed.


RESULTS
From January 2000 through December 2007, 1,588 patients were diagnosed to have STEMI and received emergent cardiac catheterization. The 38 (2.4%) of these 1,588 patients were enrolled into the present study due to LMCA obstruction. The analytical results identified the 30-day mortality rate as 42.1% (16/38). Multivariate analysis demonstrated that renal insufficiency was independently predictive of in-hospital mortality (odds ratio (OR): 5.642; p = 0.029), whereas successful revascularization was independently predictive of freedom from in-hospital mortality (OR: 0.174; p = 0.044). The cut-off value of a Parsonnet score > 20 was strongly associated with 30-day mortality (p = 0.002).


CONCLUSIONS
Even undergoing emergency revascularization for patients with acute LMCA obstruction, the in-hospital mortality remains very high. Additionally, the worse clinical outcome was observed in those with renal insufficiency and Parsonnet score of > 20.
Cheng
Cheng-I
CI
Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taiwan, R.O.C.
Hsueh
Shu-Kai
SK
Lee
Fan-Yen
FY
Wu
Chiung-Jen
CJ
Fang
Chih-Yuan
CY
Sheu
Jiunn-Jye
JJ
Chen
Shyh-Ming
SM
Yang
Cheng-Hsu
CH
Hsieh
Yuan-Kai
YK
Chen
Mien-Cheng
MC
Fu
Morgan
M
Yip
Hon-Kan
HK