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Both cardiogenic shock (CS) and critical culprit lesion locations (CCLLs), defined as the left main trunk and proximal left anterior descending coronary artery, are associated with worse outcomes in ST-elevation myocardial infarctions (STEMIs). We aimed to examine how the combination of CS and/or CCLLs affected the prognosis in Japanese STEMI patients in the primary percutaneous coronary intervention era (PPCI-era). The subjects included 624 STEMI patients admitted to our hospital between January 2013 and April 2020. They were divided into four groups according to the combination of CS and CCLLs: CS (−) CCLL (−) group [n = 405], CS (−) CCLL (+) group [n = 150], CS (+) CCLL (−) group [n = 25], and CS (+) CCLL (+) group [n = 44].The cumulative incidences of all-cause death at 30 days and 1 year were 3.5% and 6.4% in the CS (−) CCLL (−), 3.3% and 5.6% in the CS (−) CCLL (+), 32.0% and 32.0% in the CS (+) CCLL (−), and 50.0% and 65.9% in the CS (+) CCLL (+) group, respectively. After a multivariate adjustment, the CS (+) CCLL (+) group was independently associated with all-cause death (hazard ratio: 17.00, 95% confidence interval: 7.12-40.59 versus the CS (−) CCLL (−) group). In the CS (+) CCLL (+) group, compared to years 2013-2017, the IMPELLA begun to be used (44.4% versus 0%), and intra-aortic balloon pumps significantly decreased (44.4% versus 92.3%) during years 2018-2020, while the medications upon discharge did not significantly differ. The 30-day mortality was numerically lower during years 2018-2020 than years 2013-2017 (Log-rank test, P = 0.092). In conclusion, the prognosis of STEMIs varies greatly depending on the combination of CS and CCLLs, and in particular, patients with both CS and CCLLs had the poorest prognosis during the modern PPCI-era.

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Although the association between periodontitis (PD) and acute myocardial infarctions (AMIs) is known, it is unclear whether the severity of the PD is associated with the atherosclerotic cardiovascular status (ASCVS) degree in patients with AMIs. We prospectively investigated 50 patients with AMIs admitted to the Nihon University Itabashi Hospital from July 2019 to May 2022. All patients were classified according to the presence and severity of the PD. The periodontal status was defined by radiographic bone loss in accordance with previous studies (healthy; ≥80% remaining bone [RB], mild-moderate PD; 66 ≤ RB < 80%, and severe PD; RB < 66%), and the degree of the ASCVS was compared. The low-density lipoprotein/high-density lipoprotein ratio significantly increased from healthy to mild-moderate PD to severe PD. The SYNTAX score was numerically higher according to the severity of the PD. The carotid intima-media thickness (cIMT) (p = 0.025) and E/e’ value (p = 0.009) were highest in the severe PD group. The cIMT and E/e’ had a significant negative correlation with the PD (Person’s correlation coefficients; r=-0.296, p = 0.037, and r=-0.411, p = 0.003, respectively). We found that the severity of the PD was associated with carotid atherosclerosis and cardiac diastolic dysfunction in AMI patients, suggesting the importance of scrutinizing PD in AMI practice.