Abstract 346: Predictors of In-Hospital Outcome After Primary PCI of Left Main Coronary Artery Acute Myocardial Infarction With Cardiogenic Shock
Background: In patients with acute myocardial infarction (AMI) and cardiogenic shock, emergency revascularization improves long-time survival. However, predictors of in-hospital outcome after primary PCI of left main coronary artery (LMCA) AMI remain unclear.
Methods: Consecutive 21 patients admitted to our hospital presenting Killip IV heart failure and occluded LMCA on emergent coronary angiogram were enrolled. We performed primary PCI of LMCA. Patients’ clinical background, angiographic findings, results of primary PCI, laboratory data, usage of circulatory supporting devices (IABP and PCPS), performance of distal protection or not, and elapsed time (from onset to reperfusion) were retrospectively examined. Patients who died in hospital and those who survived were compared.
Results: Successful reperfusion was achieved in 21 (100%) patients; IABP was used in 21 (100%) but PCPS in 6 (29%) patients; and 13 (62%) patients survived but 6 (29%) patients died in hospital. Elapsed time (5.1±2.5 vs. 2.8±1.0 hours; p<0.05) was shorter in patients who survived than in those who died, and peak CK (15509±8686 vs. 6608±3613 U/l; p<0.05) and peak CK-MB (567±316 vs. 925±387 U/l; p<0.05) were higher in patients who died than in those who survived. And wide QRS in electro cardiogram was found more frequently in patients who died than in those who survived. In addition, we performed distal protection more frequently in patients who survived than in those who died.
Conclusion: Short elapsed time and small infarct size were associated with good in-hospital outcome. Therefore, sooner primary PCI of LMCA should be an effective therapeutic strategy for LMCA AMI resenting cardiogenic shock. In addition, we should perform distal protection as possible as we can even in LMCA AMI cases.
- © 2013 by American Heart Association, Inc.