Angiographic and procedural characteristics.

ObjectivesWe evaluated the clinical impact of residual non-culprit left main coronary artery disease (LMCAD) on prognosis in patients undergoing emergent percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).MethodsA total of 429 patients who underwent PCI for AMI complicated by CS was enrolled from 12 centers in the Republic of Korea. The patients were divided into two groups according to presence of non-culprit LMCAD or not: the LMCAD non-culprit group (n = 43) and the no LMCAD group (n = 386). Primary outcome was major adverse cardiac event (MACE, defined as a composite of cardiac death, myocardial infarction, or repeat revascularization). Propensity score matching analysis was performed to reduce selection bias and potential confounding factors.ResultsDuring a 12-month follow-up, a total of 168 MACEs occurred (LMCAD non-culprit group, 17 [39.5%] vs. no LMCAD group, 151 [39.1%]). Multivariate analysis revealed no significant difference in the incidence of MACE at 12 months between the LMCAD non-culprit and no LMCAD groups (adjusted hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.58 to 1.62, p = 0.901). After propensity score matching, the incidence of MACE was still similar between the two groups (HR 0.64; 95% CI 0.33 to 1.23; p = 0.180). The similarity of MACEs between the two groups was consistent across a variety of subgroups.ConclusionsAfter adjusting for baseline differences, residual non-culprit LMCAD does not appear to increase the risk of MACEs at 12 months in patients undergoing emergent PCI for AMI complicated by CS.研究目的 本研究旨在评估合并心源性休克（cardiogenic shock, CS）的急性心肌梗死（acute myocardial infarction, AMI）患者接受急诊经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）时，残留非罪犯病变左主干冠状动脉疾病（left main coronary artery disease, LMCAD）对预后的临床影响。 方法 本研究从韩国12个医学中心纳入429例因合并CS的AMI接受PCI的患者。根据是否存在非罪犯病变LMCAD将患者分为两组：非罪犯病变LMCAD组（n=43）与无LMCAD组（n=386）。本研究的主要终点为主要不良心血管事件（major adverse cardiac event, MACE），定义为心源性死亡、心肌梗死或再次血运重建的复合终点。为减少选择偏倚与潜在混杂因素，本研究采用倾向得分匹配（propensity score matching）分析。 结果 在12个月随访期间，共发生168例MACE事件：非罪犯病变LMCAD组为17例（39.5%），无LMCAD组为151例（39.1%）。多因素分析显示，非罪犯病变LMCAD组与无LMCAD组患者12个月时的MACE发生率无显著差异（校正后风险比（hazard ratio, HR）为0.97，95%置信区间（confidence interval, CI）为0.58~1.62，P=0.901）。经倾向得分匹配后，两组的MACE发生率仍无显著差异（HR=0.64；95%CI：0.33~1.23；P=0.180）。两组间MACE事件的相似性在各类亚组中均保持一致。 结论 在校正基线差异后，对于合并CS的AMI接受急诊PCI的患者，残留非罪犯病变LMCAD并未增加其12个月时的MACE发生风险。