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- Title
Long-term prognosis of patients with acute myocardial infarction due to unprotected left main coronary artery disease: a single-centre experience over 14 years.
- Authors
Li Xu; Hao Sun; Le-Feng Wang; Xin-Chun Yang; Kui-Bao Li; Da-Peng Zhang; Hong-Shi Wang; Wei-Ming Li; Xu, Li; Sun, Hao; Wang, Le-Feng; Yang, Xin-Chun; Li, Kui-Bao; Zhang, Da-Peng; Wang, Hong-Shi; Li, Wei-Ming
- Abstract
<bold>Introduction: </bold>Acute 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.<bold>Methods: </bold>From 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.<bold>Results: </bold>Cardiogenic 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).<bold>Conclusion: </bold>AMI 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.
- Subjects
CATASTROPHIC illness; CORONARY disease; CARDIOGENIC shock; MYOCARDIAL infarction; MULTIVARIATE analysis; PATIENTS; PROGNOSIS; CORONARY heart disease treatment; MYOCARDIAL infarction diagnosis; MYOCARDIAL infarction treatment; ANGIOGRAPHY; CARDIOVASCULAR system; CORONARY arteries; HOSPITAL care; LONGITUDINAL method; MEDICAL care; MYOCARDIAL revascularization; REGRESSION analysis; TRANSLUMINAL angioplasty; PROPORTIONAL hazards models; RETROSPECTIVE studies; KAPLAN-Meier estimator; ODDS ratio
- Publication
Singapore Medical Journal, 2016, Vol 57, Issue 7, p396
- ISSN
0037-5675
- Publication type
journal article
- DOI
10.11622/smedj.2016121