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In patients with acute myocardial infarction (AMI) and cardiogenic shock, emergency revascularization improves long-time survival. However, predictors of in-hospital outcome after primary PCI of left main coronary artery (LMCA) AMI remain unclear.
Consecutive 19 patients admitted to our hospital presenting Killip IV heart failure and occluded LMCA on emergent coronary angiogram were enrolled. We performed primary PCI of LMCA.
Patients' clinical background, angiographic findings, results of primary PCI, laboratory data, usage of circulatory supporting devices (IABP and PCPS), and elapsed time (from onset to reperfusion) were retrospectively examined. Patients who died in hospital and those who survived were compared.
Successful reperfusion was achieved in 19 (100%) patients; IABP was used in 19 (100%) but PCPS in 6 (32%) patients; and 13 (68%) patients survived but 6 (32%) patients died in hospital. Prevalence of diabetes mellitus (83% vs. 23%; p<0.05), elapsed time (5.8±2.6 vs. 2.8±1.0 hours; p<0.05), and peak CK (15272±10263 vs. 6608±3612 U/l; p<0.05) were larger in patients who died than in those who survived.
Short elapsed time, small infarct size, and non-diabetic patients were associated with good in-hospital outcome. Therefore, sooner primary PCI of LMCA should be an effective therapeutic strategy for LMCA AMI presenting cardiogenic shock.
- 2013 American College of Cardiology Foundation