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Related Concept Videos

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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
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Primary stenting for left-main shock syndrome.

Masahisa Yamane1, Soushin Inoue, Akiko Yamane

  • 1The Division of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan (M.Y., A.Y., O.K., H.Y.);and the Division of Cardiology, Hino Municipal Hospital, Tokyo, Japan (S.I.).

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|September 18, 2009
PubMed
Summary

Early percutaneous coronary intervention (PCI) using stenting effectively treats acute myocardial infarction (AMI) with unprotected left main shock (LMS). This approach offers acceptable outcomes despite high initial morbidity in complex coronary artery disease patients.

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Published on: April 25, 2014

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Unprotected left main (LM) disease complicating acute myocardial infarction (AMI) is associated with high mortality.
  • Optimal management strategies for AMI with unprotected LM shock (LMS) remain debated, especially with advancements in percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To evaluate the clinical outcomes of early primary stenting for unprotected left main lesions in patients presenting with AMI and cardiogenic shock.
  • To assess the feasibility and effectiveness of PCI in this high-risk patient population.

Main Methods:

  • A consecutive series of 25 patients with AMI and unprotected LMS underwent primary stenting with bare metal stents.
  • Conventional supportive measures were employed alongside the PCI procedure.
  • Coronary angiography (CAG) and assessment of TIMI flow were performed before and after intervention.

Main Results:

  • Successful TIMI grade 3 flow was achieved in 84% of patients post-PCI.
  • The 30-day mortality rate was 32%, with an overall 12-month mortality of 40%.
  • Major adverse cardiac events occurred in 68% of patients within 12 months, including death, re-infarction, stroke, and target vessel revascularization.

Conclusions:

  • Prompt application of stenting for AMI complicated by unprotected LMS can be an effective treatment strategy.
  • PCI in this setting can lead to acceptable, though significant, rates of mortality and morbidity.
  • Further research is warranted to optimize management and improve long-term outcomes.