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目的 分析无保护左主干(ULMCA)病变导致急性心肌梗死(AMI)合并心源性休克(CS)患者的临床表现和近、远期预后.方法 从1999年1月至2014年5月,共完成5 798例急诊冠状动脉造影,入选经急诊造影证实梗死相关血管(IRA)为ULMCA的AMI患者.根据住院期间是否存在CS将患者分为休克组和对照组,收集入选患者的临床资料、造影及介入治疗资料.比较两组患者的临床情况和近、远期临床随访结果.分析ULMCA病变导致AMI患者合并CS的临床特点,以及合并CS对该类患者近、远期临床预后的影响.结果 最终有58例ULMCA病变所致AMI患者纳入研究,其中31例患者(53.4％)存在CS.与对照组比较,CS组患者术前侧支循环2～3级的比率、最终的TIMI血流3级比率和左室射血分数较低.Logistic回归分析则提示仅有较低的术前侧支循环2-3级是住院期间发生CS的预测因素(OR =0.19,P=0.02).住院期间一共死亡23例(39.7％),其中休克组住院病死率明显高于对照组(64.5％ vs.11.1％,P＜0.01).Logistic回归分析提示CS是住院期间死亡的预测因素(OR =6.94,P=0.01).35例患者存活出院,完成中位数42.0个月(12.0,60.0)的随访.Kaplan-Meier分析估算无休克患者的总累计生存率为51.8％,而休克患者的总累计生存率仅为20.3％(Log-rank,P＜0.01).COX多因素回归分析显示,住院期间存在CS则是ULMCA病变所致AMI患者总病死率的唯一预测因素(HR =4.67,P=0.004).结论 ULMCA病变所致的AMI患者病情凶险,CS发生率高,CS与该类患者近、远期病死率相关.“,”Objective To analyze the clinical characteristics and prognosis of the patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) due to unprotected left-main coronary artery (ULMCA) disease.Methods From January 1999 to May 2014,5 798 emergency coronary angiographies were performed.The AMI patients with infarction of related artery of ULMCA conformed by angiography were enrolled.Clinical characteristics and prognosis of the patients were studied.The patients were divided into two groups according to the occurrence of CS during hospitalization.The interventional data and outcome during short term and long term followed up were compared between the two groups.The causes of CS and mortality were analyzed.Results Fifty-eight patients were enrolled,and CS occurred in 31 patients (53.4％).Compared with CS free group,left ventricular ejection fraction,occurrence of TIMI grade 2-3 during diagnostic angiography,collateral circulation with Rentrop grade 2-3 and final flow of TIMI grade 3 were lower in the group with CS.Logistic analysis revealed poor collateral circulation (less than Rentrop grade 2) was related with occurrence of CS (OR =0.19,P =0.02).Twenty-three patients died in hospital,and the mortality in CS group was higher than that in the group without CS (64.5％ vs.11.1％,P ＜0.01).CS was confirmed as a powerful predictor of in-hospital mortality by Logistic analysis (OR =6.94,P =0.01).Long term follow up was performed in the 35 survivors with the duration of median time of 42.0 (12.0,60.0) months.The accumulative total survival rate was 20.3％ in patients with CS and 51.8％ in patients without CS (Log-rank,P ＜ 0.01).Multivariable COX regression analysis revealed the only independent predictor of total mortality during long-term follow up was CS during hospitalization (HR =4.67,P =0.004) . Conclusions AMI due to ULMCA disease was critically risky with high incidence of CS.The short term and long term prognosis of these patients with AMI caused by ULMCA disease complicated with CS was poor.