Is the Prognosis Favourable in Patients without Cardiogenic Shock on Admission Following Acute Myocardial Infarction in the Left Main Trunk?

Abstract

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.