Electrocardiographic and clinical predictors for in-hospital mortality in patients with acute myocardial infarction caused by left main coronary artery occlusion.

The data on prediction for early mortality in patients with acute myocardial infarction (AMI) caused by total left main (LM) occlusion are limited. We aim to evaluate predictors for early mortality in these extremely high-risk patients. In this retrospective study, all consecutive patients with total occlusive LM-AMI were included between January 1997 and October 2023. The ECG and clinical data were compared between the in-hospital mortality and survival groups. The receiver operating characteristic curve (ROC) was created to identify the best predictors of in-hospital mortality. The primary endpoint was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events. A total of 116 patients were included. The in-hospital mortality was 47% (54/116), and the 5-year MACE-free survival rate was 44%. ST-elevation myocardial infarction (STEMI), cardiogenic shock, STEMI plus shock, STEMI plus left anterior fascicular block (LAFB) + right bundle branch block (RBBB), post-procedural TIMI I to II flow, and collateral flow absence were associated with in-hospital death, with the area under ROC (AUC) of 0.726, 0.704, 0.782, 0.605, 0.633, and 0.671, respectively. ST-elevation in aVR and ST-elevation in aVR + aVL were more common in the survival group. STEMI plus shock showed a significantly greater AUC than the other predictors (82% specificity and 74% sensitivity, Z = 1.980, P < .05). STEMI plus LAFB + RBBB predicted in-hospital mortality with a specificity of 95% and a sensitivity of 26%. ECG features were associated with shock and collateral circulation. Patients with shock presented with more STEMI, LAFB + RBBB, STEMI plus LAFB + RBBB, collateral flow absence, prolonged QRS interval, and less ST-elevation in aVR (P < .05). STEMI plus shock is a valuable predictor for in-hospital mortality in patients with acute total LM occlusion. STEMI plus LAFB + RBBB predicted a fatal in-hospital outcome in LM occlusion with high specificity.