BACKGROUND: Acute myocardial infarction (AMI) due to left main coronary artery disease is associated with significantly elevated morbidity and mortality. The aim of this study was to identify the predictors of in-hospital death from left main AMI complicated by cardiogenic shock. METHODS: Clinical record review identified a total of 25 cases of left main AMI with cardiogenic shock. Patients' background characteristics, laboratory data, and angiographic findings were analyzed according to the in-hospital mortality. RESULTS: In this patient subset, in-hospital mortality (60%) was associated with a history of hypertension (p=0.02) and a higher heart rate (p=0.02). Furthermore, in-hospital mortality was also associated with a complete right bundle branch block (CRBBB) pattern in the admission ECG (p=0.01) and low HCO(3)(-) (p=0.0004). In stepwise logistic regression analysis, a CRBBB pattern (OR 48.59, 95% CI 1.34-1768.10, p=0.03) and low HCO(3)(-) (OR 0.62, 95% CI 0.40-0.94, p=0.02) were found to be independent predictors of mortality. CONCLUSIONS: Left main AMI with cardiogenic shock was associated with high in-hospital mortality. A CRBBB pattern in the ECG on admission and a low HCO(3)(-) concentration were significant independent predictors of in-hospital death.
BACKGROUND: Acute myocardial infarction (AMI) due to left main coronary artery disease is associated with significantly elevated morbidity and mortality. The aim of this study was to identify the predictors of in-hospital death from left main AMI complicated by cardiogenic shock. METHODS: Clinical record review identified a total of 25 cases of left main AMI with cardiogenic shock. Patients' background characteristics, laboratory data, and angiographic findings were analyzed according to the in-hospital mortality. RESULTS: In this patient subset, in-hospital mortality (60%) was associated with a history of hypertension (p=0.02) and a higher heart rate (p=0.02). Furthermore, in-hospital mortality was also associated with a complete right bundle branch block (CRBBB) pattern in the admission ECG (p=0.01) and low HCO(3)(-) (p=0.0004). In stepwise logistic regression analysis, a CRBBB pattern (OR 48.59, 95% CI 1.34-1768.10, p=0.03) and low HCO(3)(-) (OR 0.62, 95% CI 0.40-0.94, p=0.02) were found to be independent predictors of mortality. CONCLUSIONS: Left main AMI with cardiogenic shock was associated with high in-hospital mortality. A CRBBB pattern in the ECG on admission and a low HCO(3)(-) concentration were significant independent predictors of in-hospital death.
Authors: Petr Widimsky; Filip Rohác; Josef Stásek; Petr Kala; Richard Rokyta; Boyko Kuzmanov; Martin Jakl; Martin Poloczek; Jan Kanovsky; Ivo Bernat; Ota Hlinomaz; Jan Belohlávek; Ales Král; Vratislav Mrázek; Vladimir Grigorov; Slaveyko Djambazov; Robert Petr; Jiri Knot; Dana Bílková; Michaela Fischerová; Karel Vondrák; Marek Maly; Alena Lorencová Journal: Eur Heart J Date: 2011-09-01 Impact factor: 29.983