title: Clinical outcomes and predictors of unprotected left main stem culprit lesions in patients with acute ST segment elevation myocardial infarction.
abstract: OBJECTIVE
  We aimed at comparing the clinical outcomes of the patients who underwent percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI) due to left main coronary arteries (LMCA) and non-LMCA determining the predictors of mortality in the patients.
  
  
  BACKGROUND
  There are few data regarding the midterm prognosis of STEMI due to LMCA as compared with them due to non-LMCA.
  
  
  METHODS
  A total of 4,697 patients with STEMI (61 patients with LMCA and 4,636 patients with non-LMCA) were enrolled in a nationwide Korea Acute Myocardial Infarction (MI) Registry between November 2005 and September 2009. The primary endpoints was a composite of cardiac death, nonfatal MI, and target lesion and vessel revascularization (TLR/TVR) during a 12-month clinical follow-up.
  
  
  RESULTS
  The LMCA group had a higher incidence of total major adverse cardiac events (MACEs) (26.2% vs. 7.8%; P < 0.001) at 12 months, which was largely attributable to cardiac deaths at 1 month (21.3% vs. 3.8%; P < 0.001). Therefore, there was no statistical difference in cardiac deaths, nonfatal MI, TLR/TVR, and MACEs after 1 month between the two groups. Presenting in cardiogenic shock (HR, 4.25; 95% CI, 1.01-17.97; P = 0.049) and heart rate ≥100 bpm (HR, 4.97; 95% CI, 1.18-21.00; P = 0.029) were independent predictors of cardiac death due to LMCA.
  
  
  CONCLUSIONS
  Patients with STEMI and a LMCA had poor clinical outcomes, which is attributable to hemodynamic deterioration during the periprocedural period. However, after that time, midterm MACEs of the survivors following the periprocedural period may not be different between STEMI due to LMCA and non-LMCA.
authors: Department of Medicine, Division of Cardiology, The Catholic University, Seoul St. Mary's Hospital, Korea, Seocho-Gu, Seoul 137-701, Republic of Korea.
authors: Ju Yeol
authors: JY
authors: Baek
authors: Suk Min
authors: SM
authors: Seo
authors: Hun-Jun
authors: HJ
authors: Park
authors: Pum Joon
authors: PJ
authors: Kim
authors: Mahn Won
authors: MW
authors: Park
authors: Yoon Seok
authors: YS
authors: Koh
authors: Ki Yuk
authors: KY
authors: Chang
authors: Myung Ho
authors: MH
authors: Jeong
authors: Seung Jung
authors: SJ
authors: Park
authors: Ki-Bae
authors: KB
authors: Seung
mesh_terms: D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome