Determinants of in-hospital death in left main coronary artery myocardial infarction complicated by cardiogenic shock

• Published in: Journal of cardiology Vol. 52; no. 1; pp. 24 - 29
• Main Authors: Sakakura, Kenichi, MD, Kubo, Norifumi, MD, Hashimoto, Shigemasa, MD, Ikeda, Nahoko, MD, Funayama, Hiroshi, MD, Hirahara, Taishi, MD, Sugawara, Yoshitaka, MD, Yasu, Takanori, MD, FJCC, Ako, Junya, MD, Kawakami, Masanobu, MD, Momomura, Shin-ichi, MD, FJCC
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.08.2008
• Subjects: Acute myocardial infarction; Bundle-Branch Block - complications; Cardiovascular; Coronary Angiography; Electrocardiography; Female; Heart Rate; Humans; Hypertension - complications; In-hospital death; Inpatients; Left main; Male; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Regression Analysis; Shock; Shock, Cardiogenic - complications; Shock; Left main; In-hospital death; Acute myocardial infarction
• DOI: 10.1016/j.jjcc.2008.03.008
• ISSN: 0914-5087

Summary 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 HCO3− ( 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 HCO3− (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 HCO3− concentration were significant independent predictors of in-hospital death.