[Myocardial infarction caused by acute left main coronary artery occlusion. Apropos of 4 cases and review of the literature].
Between 1979 and 1996, 4 acute occlusions of the left main coronary artery (LMC) were treated by primary transluminal coronary angioplasty. They were 4 men with a mean age of 43 +/- 5 years, admitted to hospital less than 8 hours after the clinical onset of symptoms of anterior myocardial infarction in Killip class 4 with complete right bundle branch block on the initial electrocardiogramme. All cases had a previous history of unstable angina over 2 to 15 days. Angioplasty was undertaken immediately in view of the haemodynamic instability. The coronary circulation was of a dominant right coronary type in the 4 cases: significant stenoses were discovered after recanalisation, on the left anterior descending artery (LAD) in 2 cases and the circumflex or marginal arteries in 3 cases. The right coronary artery was atheromatous in all cases but without significant stenosis. Angioplasty was completed by implantation of a stent in 3 cases (LAD : 1 case, LMC : 2 cases). The outcome was rapidly fatal in 3 cases. Only one patient survived 6 months in functional class 3. These results show that myocardial infarction due to occlusion of the left main coronary artery is a very severe condition which justifies rapid recanalisation. Primary angioplasty with stent implantation in an immediate therapeutic option which enables the patient to survive the acute stage, though only in a limited number of cases.
Gilard
M
M
Département de cardiologie, centre hospitalier de la Cavale Blanche, Brest.
Bouquin
V
V
Boschat
J
J
Provost
K
K
Jobic
Y
Y
Larlet
J M
JM
Guillo
P
P
Blanc
J J
JJ
D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications* / Q000628:therapy; D004630:Emergencies; D017809:Fatal Outcome; D005500:Follow-Up Studies; D006327:Heart Block / Q000209:etiology; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000628:therapy; D011183:Postoperative Complications; D015607:Stents; D016896:Treatment Outcome
Infarctus du myocarde par occlusion aiguë du tronc commun gauche. A propos de 4 cas et revue de la littérature.