Clinical presentation and prognostic factors of patients with acute ST-segment elevation myocardial infarction following emergent revascularization for left main coronary artery obstruction

Background: Acute ST-segment elevation myocardial infarction (STEMI) caused by left main coronary artery (LMCA) obstruction is uncommon. Although the link between this catastrophic disease and very high mortality is well recognized, even after undergoing emergent revascularization, the systemic risk stratification and longterm outcome are currently unclear. The clinical presentation, parameter-related in-hospital death and long-term outcomes of these patients with acute LMCA obstruction undergoing emergency revascularization were carefully reviewed. Methods and Results: From January 2000 through December 2007, 1,588 patients were diagnosed to have STEMI and received emergent cardiac catheterization. The 38 (2.4%) of these 1,588 patients were enrolled into the present study due to LMCA obstruction. The analytical results identified the 30-day mortality rate as 42.1% (16/38). Multivariate analysis demonstrated that renal insufficiency was independently predictive of in-hospital mortality (odds ratio (OR): 5.642; p=0.029), whereas successful revascularization was independently predictive of freedom from in-hospital mortality (OR: 0.174; p=0.044). The cut-off value of a Parsonnet score >20 was strongly associated with 30-day mortality (p=0.002). Conclusions: Even undergoing emergency revascularization for patients with acute LMCA obstruction, the inhospital mortality remains very high. Additionally, the worse clinical outcome was observed in those with renal insufficiency and Parsonnet score of >20.