title: Outcomes according to presentation with versus without cardiogenic shock in patients with left main coronary artery stenosis and acute myocardial infarction.
abstract: This study is aimed at evaluating 1-year clinical outcomes and their predictors in patients with unprotected left main coronary artery (ULMCA)-related acute myocardial infarction (AMI). In total 248 patients diagnosed with AMI involving the ULMCA as the culprit vessel and registered in the Korean Acute Myocardial Infarction database were enrolled in this study. Patients were divided according to the absence (shock-, n = 206) or presence (shock+, n = 42) of cardiogenic shock at initial presentation. Independent risk factors of in-hospital cardiac death associated with ULMCA-related AMI were elucidated by multivariate regression analysis. In-hospital mortality rates were 8.7% in the shock- group and 47.6% in the shock+ group (p = 0.001). During 1-year follow-up after discharge, major adverse cardiac events developed in 16.3% of patients in the shock- group and 18.2% of patients in the shock+ group (p = 0.828); cardiac death, MI, and ischemia-driven target vessel revascularization were similar between the 2 groups at 1 year. On multivariate analysis, initial shock presentation (odds ratio 8.9, confidence interval 4.1 to 19.2, p = 0.004) and left ventricular ejection fraction <30% (odds ratio 7.6, confidence interval 2.7 to 21.1, p = 0.001) were independent risk factors of in-hospital cardiac death associated with ULMCA-related AMI. In conclusion, almost 1/2 of patients with ULMCA-related AMI presenting with cardiogenic shock had a fatal in-hospital outcome compared to <10% of those without cardiogenic shock; however, clinical outcomes after survival of the in-hospital period were not different between these groups.
authors.affiliation: Yeungnam University Medical Center, Deagu, Korea.
authors.forename: Ung
authors.initials: U
authors.lastname: Kim
authors.forename: Jong-Seon
authors.initials: JS
authors.lastname: Park
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Kang
authors.forename: You-Min
authors.initials: YM
authors.lastname: Kim
authors.forename: Won-Jong
authors.initials: WJ
authors.lastname: Park
authors.forename: Sang-Hee
authors.initials: SH
authors.lastname: Lee
authors.forename: Geu-Ru
authors.initials: GR
authors.lastname: Hong
authors.forename: Dong-Gu
authors.initials: DG
authors.lastname: Shin
authors.forename: Young-Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: In-Whan
authors.initials: IW
authors.lastname: Song
authors.forename: Taek Jong
authors.initials: TJ
authors.lastname: Hong
authors.forename: In Ho
authors.initials: IH
authors.lastname: Chae
authors.forename: Myeong Chan
authors.initials: MC
authors.lastname: Cho
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Junghan
authors.initials: J
authors.lastname: Yoon
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Seung Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016017:Odds Ratio; D011379:Prognosis; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome