Key result
In-hospital mortality was 70.8% in patients with LM-AMI presenting with cardiogenic shock and 22.3% in those without shock, with Killip class III strongly predicting death in the non-shock group.
Why the study?
To clarify differences in prognosis and factors associated with in-hospital death for patients with LM-AMI presenting with versus without cardiogenic shock on admission.
Does the presence of cardiogenic shock on admission affect the prognosis and risk factors for in-hospital death in patients with acute myocardial infarction in the left main trunk?
Observational (n=183)
Yes
Does the presence of cardiogenic shock on admission affect the prognosis and risk factors for in-hospital death in patients with acute myocardial infarction in the left main trunk?
In patients with left main acute myocardial infarction, in-hospital mortality is high even without cardiogenic shock on admission, driven by heart failure severity, whereas mortality in those with cardiogenic shock is driven by coronary slow-flow after PCI.
High LM-AMI mortality without shock warrants HF vigilance; observational data leaves open targeted strategies to improve outcomes.
Background: Acute myocardial infarction in the left main trunk (LM-AMI) is a rare but serious condition. The purpose of the present study was to clarify differences in prognosis and factors associated with in-hospital death for patients with LM-AMI with or without CS on admission. Methods: The present retrospective observational study cohort consisted of 183 patients with LM-AMI in the registry of the Cardiovascular Research Consortium-8 Universities in eastern Japan between 1997 and 2016. The patients with LM-AMI were divided into two groups: those with CS on admission and those who did not have CS on admission. Results: In-hospital mortality in the CS and the non-CS group was 70.8% and 22.3%, respectively. In the non-CS group, the in-hospital mortality significantly increased along with increased Killip class (p = 0.028). Multivariate analysis showed a significantly elevated HR of 5.59 (95% CI, 1.24 to 25.26; p = 0.025) for in-hospital death among patients in the non-CS group categorized into Killip classification III. In contrast, in the CS group, the HR of coronary slow-flow after percutaneous coronary intervention for in-hospital death was 3.08 (95% CI, 1.52 to 6.25; p = 0.002). Conclusions: The prognosis of the non-CS group among patients with LM-AMI was also worse. The risk factors for in-hospital death between the CS and non-CS groups were different. Even for the non-CS group, the severity of heart failure was correlated with in-hospital death.
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Morioka et al. (2020) conducted an observational in Acute myocardial infarction in the left main trunk (LM-AMI) (n=183). Cardiogenic shock (CS) on admission vs. No cardiogenic shock on admission was evaluated on In-hospital mortality. In-hospital mortality was 70.8% in patients with LM-AMI presenting with cardiogenic shock and 22.3% in those without shock, with Killip class III strongly predicting death in the non-shock group.
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