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Updated: Jun 28, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Left main percutaneous coronary intervention in ST elevation myocardial infarction
Ruben Ramos1, Lino Patrício, Ana Abreu
1Serviço de Cardiologia, Hospital de Santa Marta, Lisboa, Portugal. nebursomar79@yahoo.com
Insights
ST-elevation myocardial infarction (STEMI) involving the left main artery is a severe emergency. Primary percutaneous coronary intervention (PCI) showed high in-hospital mortality but good mid-term survival for STEMI patients with left main occlusion.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- ST-elevation myocardial infarction (STEMI) affecting the left main coronary artery is a rare but critical emergency.
- This condition is associated with a poor prognosis, necessitating urgent intervention.
Purpose of the Study:
- To evaluate the outcomes and prognosis of primary percutaneous coronary intervention (PCI) for STEMI caused by left main artery occlusion.
- Analysis focused on in-hospital mortality and major adverse cardiac events (MACE) at 12-month follow-up.
Main Methods:
- Retrospective analysis of 9 patients undergoing PCI for left main STEMI between August 2004 and July 2006.
- Patients received either primary PCI or rescue PCI, with detailed data on interventions and clinical outcomes.
Main Results:
- High in-hospital mortality rate (55%), with 7 patients presenting in cardiogenic shock or Killip class II.
- Drug-eluting stents were predominantly used; adjunctive therapies included intra-aortic balloon pump and abciximab.
- Of the 4 survivors, all were free from MACE at 12-month follow-up, indicating good mid-term prognosis.
Conclusions:
- STEMI with left main culprit lesion represents a severe clinical scenario with high immediate mortality.
- Despite high mortality, primary PCI with modern techniques and support (stents, IABP, abciximab) offers a favorable mid-term prognosis for survivors.
Background:
ST-elevation myocardial infarction (STEMI) with the culprit lesion in the left main artery is a rare cardiac emergency with a poor prognosis.
Objective:
Review and prognosis evaluation of primary percutaneous coronary intervention (PCI) performed in the setting of STEMI with left main occlusion in a single high-volume center.
Methods:
Of the 483 primary or rescue PCIs performed and followed in our hospital during a 24-month period (August 2004 to July 2006), we retrospectively evaluated those involving left main procedures and analyzed in-hospital mortality and major cardiac events (MACE) in a 12-month follow-up. We found nine patients, age 68 +/- 9 years, five male, seven with multivessel disease and two with isolated left main disease. Rescue PCI was performed in three patients and primary PCI in the others.
Results:
Seven patients presented in cardiogenic shock and two were classified in Killip class II on admission. Inotropic drugs, intra-aortic balloon pump and abciximab were used in eight patients. Drug-eluting stents were used in six patients, bare-metal stents in two, and isolated balloon angioplasty in one. Five patients (55%) died in the hospital and the four discharged home (two of them aged 81 and 82 years) were still alive and free from MACE at 12-month follow-up.
Conclusions:
Clinical presentation of STEMI with the culprit lesion in the left main artery was very severe. During PCI, drug-eluting stents, intra-aortic balloon pump and abciximab were used in almost all patients. This entity had a high mortality rate even though primary PCI was performed. Those who survived had a good mid-term prognosis.
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