title: Acute myocardial infarction due to left main coronary artery disease: a large multicenter national registry.
abstract: BACKGROUND
  Optimal management of patients with acute myocardial infarction (MI) due to critical stenosis of an unprotected left main coronary artery (ULMCA) is not established. However, data from observational studies and registries encourage to perform percutaneous coronary intervention (PCI) in high risk patients. We investigated gender-related discrepancies, clinical course and prognosis in patients with acute MI and ULMCA as an infarct-related artery.
  
  
  METHODS
  A total of 643 consecutive patients (184 [28.6%] females and 459 [71.4%] males) with acute MI due to critical ULMCA stenosis were selected from the population of 121,526 patients hospitalized due to acute coronary syndromes between 2003 and 2006. The primary endpoints were in-hospital, 30-day, 6-month and 12-month mortality.
  
  
  RESULTS
  Women were older than men with significantly higher proportion of women older than 65 and with unfavorable risk profile. The management in men and women was similar. There was no significant gender-related differences in mortality in all follow-up periods. In multivariate analysis cardiogenic shock, pulmonary edema, ST elevation myocardial infarction (STEMI) and advanced age significantly increased mortality, whereas successful PCI decreased mortality.
  
  
  CONCLUSIONS
  No significant differences in clinical course, treatment and prognosis between men and women were noted. Mortality remained very high in both genders. The most unfavorable prognostic factors were cardiogenic shock, pulmonary edema, STEMI and advanced age. Percutaneous coronary angioplasty is feasible and offers high success rate in this subset of patients.
authors.affiliation: Swietokrzyskie Cardiology Center, Kielce, Poland. emsad@o2.pl.
authors.forename: Marcin
authors.initials: M
authors.lastname: Sadowski
authors.forename: Wojciech
authors.initials: W
authors.lastname: Gutkowski
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Janion-Sadowska
authors.forename: Mariusz
authors.initials: M
authors.lastname: Gąsior
authors.forename: Marek
authors.initials: M
authors.lastname: Gierlotka
authors.forename: Marianna
authors.initials: M
authors.lastname: Janion
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D023921:Coronary Stenosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D011044:Poland / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome