title: Clinical presentation and prognostic factors of patients with acute ST-segment elevation myocardial infarction following emergent revascularization for left main coronary artery obstruction.
abstract: 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.
authors.affiliation: Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taiwan, R.O.C.
authors.forename: Cheng-I
authors.initials: CI
authors.lastname: Cheng
authors.forename: Shu-Kai
authors.initials: SK
authors.lastname: Hsueh
authors.forename: Fan-Yen
authors.initials: FY
authors.lastname: Lee
authors.forename: Chiung-Jen
authors.initials: CJ
authors.lastname: Wu
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fang
authors.forename: Jiunn-Jye
authors.initials: JJ
authors.lastname: Sheu
authors.forename: Shyh-Ming
authors.initials: SM
authors.lastname: Chen
authors.forename: Cheng-Hsu
authors.initials: CH
authors.lastname: Yang
authors.forename: Yuan-Kai
authors.initials: YK
authors.lastname: Hsieh
authors.forename: Mien-Cheng
authors.initials: MC
authors.lastname: Chen
authors.forename: Morgan
authors.initials: M
authors.lastname: Fu
authors.forename: Hon-Kan
authors.initials: HK
authors.lastname: Yip