title: Long-term prognosis of patients with acute myocardial infarction due to unprotected left main coronary artery disease: a single-centre experience over 14 years.
abstract: BACKGROUND
  Acute myocardial infarction (AMI) due to unprotected left main coronary artery (ULMCA) disease is clinically catastrophic although it has a low incidence. Studies on the long-term prognosis of these patients are rare.
  
  
  METHODS
  From January 1999 to September 2013, 55 patients whose infarct-related artery was the ULMCA were enrolled. Clinical, angiographic and interventional data was collected. Short-term and long-term clinical follow-up results as well as prognostic determinants during hospitalisation and follow-up were analysed.
  
  
  RESULTS
  Cardiogenic shock (CS) occurred in 30 (54.5%) patients. During hospitalisation, 22 (40.0%) patients died. Multivariate logistic regression analysis showed that CS (odds ratio [OR] 5.86; p = 0.03), collateral circulation of Grade 2 or 3 (OR 0.14; p = 0.02) and final flow of thrombolysis in myocardial infarction (TIMI) Grade 3 (OR 0.05; p = 0.03) correlated with death during hospitalisation. 33 patients survived to discharge; another seven patients died during the follow-up period of 44.6 ± 31.3 (median 60, range 0.67-117.00) months. The overall mortality rate was 52.7% (n = 29). Kaplan-Meier analysis showed that the total cumulative survival rate was 30.7%. Cox multivariate regression analysis showed that CS during hospitalisation was the only predictor of overall mortality (hazard ratio 4.07, 95% confidence interval 1.40-11.83; p = 0.01).
  
  
  CONCLUSIONS
  AMI caused by ULMCA lesions is complicated by high incidence of CS and mortality. CS, poor collateral blood flow and failure to restore final flow of TIMI Grade 3 correlated with death during hospitalisation. CS is the only predictor of long-term overall mortality.
authors.affiliation: Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Xu
authors.affiliation: Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Sun
authors.affiliation: Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Le-Feng
authors.initials: LF
authors.lastname: Wang
authors.affiliation: Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Xin-Chun
authors.initials: XC
authors.lastname: Yang
authors.affiliation: Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Kui-Bao
authors.initials: KB
authors.lastname: Li
authors.affiliation: Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Da-Peng
authors.initials: DP
authors.lastname: Zhang
authors.affiliation: Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Hong-Shi
authors.initials: HS
authors.lastname: Wang
authors.affiliation: Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D012770:Shock, Cardiogenic; D055815:Young Adult
keywords: acute myocardial infarction; cardiogenic shock; infarct-related artery; percutaneous coronary intervention; unprotected left main coronary artery