Percutaneous revascularization of total or subtotal left main occlusion in the setting of acute myocardial infarction

We evaluated the effect of percutaneous coronary intervention (PCI) for total or subtotal left main coronary occlusion (LMCO) in the setting of acute myocardial infarction (AMI), together with clinical features, outcome, and prognostic determinants.

Between March 2008 and June 2010, PCI was performed for total or subtotal thrombotic LMCO in eight patients with AMI. All the patients were males with a mean age of 55.5 years (range 25 to 75 years). The primary endpoints were the occurrence of major adverse cardiac events including death from any cause, nonfatal myocardial infarction, and target lesion revascularization.

Five patients were admitted with anterior AMI and three patients with non-ST elevation AMI. Seven patients were in cardiogenic shock. The mean symptom duration was 195 min (range 15 min to 10 hr). Predilatation was performed in six patients, and postdilatation was performed in two patients. Six patients received a single stent with the cross-over technique and the simultaneous kissing stent technique was used in one patient. Mortality occurred in three patients (37.5%). Two deaths developed in the catheterization laboratory, one before stent implantation. One patient died six days after the procedure due to subacute stent thrombosis. After a mean follow-up of 79 weeks (range 27 to 152 weeks), two patients underwent elective bypass surgery because of restenosis, while the rest of the patients remained free of any cardiac event.

Percutaneous coronary intervention in patients with LMCO complicated by AMI is feasible and effective, and offers a good mid-term outcome for hospital survivors.