In-hospital outcomes of acute myocardial infarction with cardiogenic shock caused by right coronary artery occlusion vs. left coronary artery occlusion.

Abstract

In-hospital outcomes of acute myocardial infarction (AMI) with cardiogenic shock (CS) were still not satisfactory even in the primary percutaneous coronary intervention (PCI) era. The aim of this study was to compare in-hospital outcomes of AMI with CS caused by right coronary artery (RCA) occlusion vs. left coronary artery (LCA) occlusion. Consecutive 894 AMI patients from January 2010 to March 2015 were screened for inclusion. A total of 114 AMI patients with CS were included as the final study population, and were divided into the RCA group (n=56) and LCA group (n=58). The patient characteristics were compared between the two groups. Multivariate logistic regression analysis was performed to show whether the RCA group was associated with better outcomes even after controlling confounding factors. In-hospital mortality was significantly lower in the RCA group (8.9%) than in the LCA group (46.6%) (P<0.001). The RCA group (vs. the LCA group) was inversely associated with in-hospital death (OR 0.08, 95% CI 0.02-0.21, P<0.001) after controlling covariates. Aspartate transaminase value (per 50U/L incremental: OR 1.22, 95% CI 1.03-1.45, P=0.02), aging (per 10-year-old incremental: OR 2.14, 95% CI 1.26-3.63, P=0.01) and using VA-ECMO (OR 22.13, 95% CI 5.22-93.90, P<0.001) were also significantly associated with in-hospital death. In conclusion, among AMI patients with CS, IRA of RCA was significantly associated with the better in-hospital outcome.