PLoS ONE (Jan 2023)

Non-culprit left main coronary artery disease in acute myocardial infarction complicated by cardiogenic shock.

  • Ik Hyun Park,
  • Woo Jin Jang,
  • Ju Hyeon Oh,
  • Jeong Hoon Yang,
  • Young Bin Song,
  • Joo-Yong Hahn,
  • Seung-Hyuk Choi,
  • Hyeon-Cheol Gwon,
  • Chul-Min Ahn,
  • Cheol Woong Yu,
  • Hyun-Joong Kim,
  • Jang-Whan Bae,
  • Sung Uk Kwon,
  • Hyun-Jong Lee,
  • Wang Soo Lee,
  • Jin-Ok Jeong,
  • Sang-Don Park

DOI
https://doi.org/10.1371/journal.pone.0276711
Journal volume & issue
Vol. 18, no. 3
p. e0276711

Abstract

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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.