title: Prognostic impact of significant non-infarct-related left main coronary artery disease in patients with acute myocardial infarction who receive a culprit-lesion percutaneous coronary intervention.
abstract: BACKGROUND
  Infarct-related left main coronary artery disease (LMCAD) is associated with an increased cardiac mortality in the setting of acute myocardial infarction (AMI). However, the prevalence and prognostic impact of significant (≥50% stenosis) non-infarct-related LMCAD in patients with AMI have not yet been elucidated.
  
  
  METHODS
  We prospectively analyzed 7655 AMI patients who had undergone a percutaneous coronary intervention (PCI) in the Korea Acute Myocardial Infarction Registry from November 2005 to January 2008. We compared major adverse cardiac events (MACEs) in AMI patients with non-infarct-related LMCAD and those without LMCAD.
  
  
  RESULTS
  Of 99 (1.3%) non-infarct-related LMCAD patients, 40 patients had undergone PCI due to their lesions on the left main coronary artery. The incidences of all-cause death, cardiac death, recurrent myocardial infarction, and composite of MACE except repeat revascularization were higher in patients with non-infarct-related LMCAD at 12 months. In Cox proportional hazard analysis for the prediction of MACE at 12 months, the hazard ratio of LMCAD was 2.189 (95% confidence interval 1.230-3.896, P=0.008). In subgroup analysis, there was no significant cumulative difference between patients who had undergone non-infarct-related left main coronary artery PCI and those who did not undergo PCI at 1 and 12 months.
  
  
  CONCLUSIONS
  The significant, non-infarct-related LMCAD in patients with AMI remains a major adverse prognostic indicator even after receiving optimal culprit-lesion PCI.
authors.affiliation: Cardiovascular Center and Cardiology Division, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Suk Min
authors.initials: SM
authors.lastname: Seo
authors.forename: Tae-Hoon
authors.initials: TH
authors.lastname: Kim
authors.forename: Chan Jun
authors.initials: CJ
authors.lastname: Kim
authors.forename: Byung Hee
authors.initials: BH
authors.lastname: Hwang
authors.forename: Min Kyu
authors.initials: MK
authors.lastname: Kang
authors.forename: Yoon Seok
authors.initials: YS
authors.lastname: Koh
authors.forename: Jinsoo
authors.initials: J
authors.lastname: Min
authors.forename: Kiyuk
authors.initials: K
authors.lastname: Chang
authors.forename: Pum Joon
authors.initials: PJ
authors.lastname: Kim
authors.forename: Hun Jun
authors.initials: HJ
authors.lastname: Park
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Chung
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Seung Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Ki-Bae
authors.initials: KB
authors.lastname: Seung
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D002423:Cause of Death; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome