Long-term prognosis of patients with acute myocardial infarction due to unprotected left main coronary artery disease: a single-centre experience over 14 years.
- Author:
Li XU
1
;
Hao SUN
1
;
Le-Feng WANG
1
;
Xin-Chun YANG
1
;
Kui-Bao LI
1
;
Da-Peng ZHANG
1
;
Hong-Shi WANG
1
;
Wei-Ming LI
1
Author Information
- Publication Type:Journal Article
- Keywords: acute myocardial infarction; cardiogenic shock; infarct-related artery; percutaneous coronary intervention; unprotected left main coronary artery
- MeSH: Adult; Aged; Angiography; Angioplasty, Balloon, Coronary; Coronary Artery Disease; pathology; therapy; Coronary Vessels; pathology; Female; Follow-Up Studies; Hospitalization; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; diagnosis; therapy; Odds Ratio; Percutaneous Coronary Intervention; Prognosis; Proportional Hazards Models; Regression Analysis; Retrospective Studies; Shock, Cardiogenic; Young Adult
- From:Singapore medical journal 2016;57(7):396-400
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTIONAcute 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.
METHODSFrom 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.
RESULTSCardiogenic 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).
CONCLUSIONAMI 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.
