Analysis of acute myocardioal infarction complicated with cardiogenic shock due to unprotected left-main coronary artery disease

Abstract

Objective To analyze the clinical characteristics and prognosis of the patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) due to unprotected left-main coronary artery (ULMCA) disease. Methods From January 1999 to May 2014, 5 798 emergency coronary angiographies were performed. The AMI patients with infarction of related artery of ULMCA conformed by angiography were enrolled. Clinical characteristics and prognosis of the patients were studied. The patients were divided into two groups according to the occurrence of CS during hospitalization. The interventional data and outcome during short term and long term followed up were compared between the two groups. The causes of CS and mortality were analyzed. Results Fifty-eight patients were enrolled, and CS occurred in 31 patients (53.4%). Compared with CS free group, left ventricular ejection fraction, occurrence of TIMI grade 2-3 during diagnostic angiography, collateral circulation with Rentrop grade 2-3 and final flow of TIMI grade 3 were lower in the group with CS. Logistic analysis revealed poor collateral circulation (less than Rentrop grade 2) was related with occurrence of CS (OR=0.19, P=0.02). Twenty-three patients died in hospital, and the mortality in CS group was higher than that in the group without CS (64.5%vs. 11.1%, P <0.01). CS was confirmed as a powerful predictor of in-hospital mortality by Logistic analysis (OR=6.94, P=0.01). Long term follow up was performed in the 35 survivors with the duration of median time of 42.0 (12.0, 60.0) months. The accumulative total survival rate was 20.3% in patients with CS and 51.8% in patients without CS (Log-rank, P <0.01). Multivariable COX regression analysis revealed the only independent predictor of total mortality during long-term follow up was CS during hospitalization (HR=4.67, P=0.004). Conclusions AMI due to ULMCA disease was critically risky with high incidence of CS. The short term and long term prognosis of these patients with AMI caused by ULMCA disease complicated with CS was poor. Key words: Acute myocardial infarction; Cardiacgenic shock; Left-main coronary artery; Percutaneous coronary intervention