BACKGROUND In cardiogenic shock with severe left main coronary artery stenosis (LM), limited information exists on short and longer-term outcomes. We sought to determine the outcomes of unprotected LM PCI in cardiogenic shock. METHODS Excluding patients with previous CABG, consecutive patients undergoing PCI in cardiogenic shock from the Melbourne Intervention Group registry between 2005 and 2013 were analysed. Those post LM PCI were compared to those post non-LM PCI. Patient and procedural data were collected with 30-day and 12-month follow-up. Australian National Death Index linkage was performed for long-term mortality analysis. RESULTS After excluding previous CABG, 18,069 procedures were performed during 1st January 2005 to 30th November 2013, 601 procedures in the setting of cardiogenic shock. Of these, 45 were performed to an isolated LM and 556 to a non-LM. Those with LM PCI were older and more likely to have a baseline left ventricular ejection fraction (LVEF) of <45%. The in-hospital, 30-day, 12-month and long-term mortality to 9 years in cardiogenic shock after LM PCI was 64.4%, 66.7%, 73.3% and 80.0% compared to 36.5%, 36.9%, 40.5% and 46.0%, after non-LM PCI (p < 0.001). On multivariate analysis, LM PCI was a significant independent predictor of long-term mortality (HR1.59, 95%CI 1.00-2.53, p = 0.048). Landmark analysis of survivors to discharge found the long-term mortality of LM PCI approaches 60% compared to 27% for those with non-LM PCI (p = 0.003). CONCLUSION Long-term outcomes after PCI to LM in cardiogenic shock are poor, with much of the excess in mortality occurring early. However, reasonable long-term survival was found beyond the initial high-risk period.

中文翻译：

---

心源性休克中经皮冠状动脉介入治疗未保护的左主冠状动脉后的长期结果。

背景技术在伴有严重左主冠状动脉狭窄（LM）的心源性休克中，关于短期和长期结果的信息有限。我们试图确定无保护的LM PCI在心源性休克中的结果。方法除2005年至2013年之间，从墨尔本干预组织注册中心分析了连续性PCI合并心源性休克的PCI患者。将LM PCI之后的产品与非LM PCI之后的产品进行比较。通过30天和12个月的随访收集患者和手术数据。进行了澳大利亚国民死亡指数链接以进行长期死亡率分析。结果在排除先前的CABG之后，于2005年1月1日至2013年11月30日进行了18,069例手术，其中有601例发生了心源性休克。这些，对孤立的LM执行45次，对非LM执行556次。LM PCI患者年龄较大，基线左心室射血分数（LVEF）<45％的可能性更大。LM PCI后心源性休克的住院，30天，12个月和至9年的长期死亡率分别为64.4％，66.7％，73.3％和80.0％，而36.5％，36.9％，40.5％和46.0非LM PCI后的百分比（p <0.001）。在多变量分析中，LM PCI是长期死亡率的重要独立预测因子（HR1.59，95％CI 1.00-2.53，p = 0.048）。对出院幸存者进行的具有里程碑意义的分析发现，LM PCI的长期死亡率接近60％，而非LM PCI的长期死亡率为27％（p = 0.003）。结论PCI到LM后心源性休克后的长期预后较差，死亡率过高的大部分发生在早期。然而，