Abstract
Objective: Acute myocardial infarction due to left main coronary artery occlusion remains catastrophic and mostly fatal due to severe cardiogenic shock and arrhythmia.Methods: We studied 13 patients undergoing coronary artery bypass grafting for acute myocardial infarction due to left main coronary artery occlusion to clarify the optimal management of these difficult patients.Results: In-hospital mortality was 46.2% (6/13). Revascularization was achieved by catheter intervention followed by bypass surgery in 7, and bypass surgery alone in 6. Two bypass surgery patients without catheter intervention had collateral flow to the left coronary artery, with the right coronary artery dominant. The time from onset to recanalization in the survival group was significantly shorter than in the early death group.Conclusions: Emergency intervention to preserve left ventricular function or right coronary artery dominant and collateral blood flow to left coronary arteries is important for improving the prognosis of patients with acute myocardial infarction due to left main coronary artery occlusion. If residual left main coronary artery stenosis is significant or other proximal coronary stenosis exists after catheter intervention, early coronary bypass surgery may improve long-term survival.
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Ellis SG, Tamai H, Nobuyoshi M. Contemporary percutaneous treatment of unprotected left main coronary stenosis initial results from multicenter registry analysis 1994–96. Circulation 1997; 96: 3867.
O’Keefe JH, Harzler GO, Rutherford BD, McConnahay DR, Johnson WL, Giorgi LV, et al. Left main coronary angioplasty: early and late results of 127 acute and elective procedures. Am J Cardio 1989; 64: 144–7.
Spiecker M, Erbel R, Rupprecht HJ, Meyer J. Emergency angioplasty of totally occluded left main coronary artery in acute myocardial infarction and unstable angina pectoris: institutional experience and literature review. Eur Heart J 1994; 15: 602.
Quigley RL, Milano CA, Smith R, White WD, Rankin JS, Glower DD. Prognosis and management of anterolateral myocardial infarction in patients with severe left main disease and cardiogenic shock. Circulation 1993; 88: II-65.
Tomioka H, Watanabe S, Hayashi K, Okada O, Minami M. Prognosis and management in patients with left main shock syndrome: emergency PTCA following CABG (Eng abstr). J Jpn Assn Thorac Surg 1998; 46: 1253–9.
Minato N, Ikeda K, Fujita H. Emergency coronary artery bypass grafting for severe ischemia in patients with left main trunk disease (Eng abstr). Kyobu Geka 1999; 52: 628–33.
Araki Y, Tashima K, Yoshikawa M, Abe T, Yamada K, Io A, et al. Successful treatment of myocardial infarction of left main trunk by emergent CABG under IABP and PCPS support (Eng abstr). Kyobu Geka 1997; 50: 923–7.
Iwasaki K, Kusachi S, Hina K, Nishiyama O, Kondo J, Kita T, et al. Acute left main coronary artery obstruction with myocardial infarction. Jpn Circ J 1993; 57:891–7.
Vanhaecke J, Flameng W, Sergeant P, De Roo M, Hovoet G, Suy R, et al. Emergency bypass surgery: late effects of size of infarction and ventricular function. Circulation 1985; 72 (Suppl II): II-179.
Bolooki H, Vrgas A. Myocardial revascularization after acute myocardial infarction. Arch Surg 1976; 111: 1216.
Park SJ, Park SW, Hong MK, Cheong SS, Lee CW, Kim JJ, et al. Stenting in unprotected left main coronary artery stenosis: immediate and late outcomes. J Am Coll Cardiol 1998; 31: 37.
Iwabuchi M, Haruta S, Taguchi A. Intravascular ultrasound findings after successful primary angioplasty for acute myocardial infarction: predictors of abrupt occlusion. JACC 1997; 30: 1437–44.
Yokoyama M, Imazeki T, Suzuki O, Kurimoto Y, Shimizu Y, Watanabe K. Benefit of the autoperfusion balloon catheter for emergency coronary artery grafting after failed percutaneus transluminal coronary angioplasty (Eng abstr). Kyobu Geka 1992; 45: 1209–11.
Kosuga K, Tamai H. Feasibility of PTCA for unprotected left main trunk disease. Resp & Circ 1998; 46: 995–9.
Moosvi AR, Khaja F, Villanueva L, Ghorghiade M, Douthat L, Goldstein S. Early revascularization improves survival in cardiogenic shock complicating acute myocardial infarction. J Am Coll Cardiol 1992; 19: 907–14.
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Shigemitsu, O., Hadama, T., Miyamoto, S. et al. Acute myocardial infarction due to left main coronary artery occlusion. Jpn J Thorac Cardiovasc Surg 50, 146–151 (2002). https://doi.org/10.1007/BF02913195
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DOI: https://doi.org/10.1007/BF02913195