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

SummaryBackgroundAcute 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.MethodsClinical 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.ResultsIn 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.ConclusionsLeft 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.