Introduction: An early invasive strategy with subsequent revascularization is recommended for patients with acute myocardial infarction complicated by cardiogenic shock. Little is known about the frequency, success rate and clinical outcome of percutaneous coronary intervention (PCI) of the left main stem in patients with cardiogenic shock. We therefore analysed a large data base of consecutive patients with PCI for cardiogenic shock.
Methods: We used the data base of the ALKK-PCI registry with consecutive interventions of 41 hospitals. Baseline characteristics, procedural features, antithrombotic therapies and hospital outcomes were prospectively collected and centrally analyse. Patients with STEMI or NSTEMI and cardiogenic shock undergoing PCI were divide into three groups: unprotected left main PCI, protected left main PCI and PCI of other coronary arteries.
Results: Between 2009 and 2014 a total of consecutive 2405 PCIs for cardiogenic shock were performed in 41 hospitals. Of these 280 (11.6 %) were done as unprocteted left main PCI, 19 (0.8 %) as protected left main PCI and 2106 (87.6%) as PCI in other coronary arteries. Baseline characteristics, procedural features and outcome are given in the table. In the multivariate analysis left main PCI remained an independend predictor of mortality (Odds ratio 1.85, 95 % CI 1.4-2.3)
Conclusions: About 12 % of all PCIs in cardiogenic shock are performed in the left main. Left main PCI is asscociated with an lower procedural success rate and a higher mortality. Therefore strategies to improve outcome in these very high risk patients are needed.