Percutaneous coronary intervention with stenting of left main coronary artery with drug-eluting stent in the setting of acute ST elevation myocardial infarction.
OBJECTIVE
Primary angioplasty of the left main coronary is not a common procedure. We present 16 cases of angioplasty of left main coronary artery with drug-eluting stent (DES) implantation in the setting of acute ST elevation myocardial infarction.


METHODS
Between December 2003 and November 2005, sixteen patients presented with acute ST elevation myocardial infarction where the left main coronary artery was shown to be involved with or without the left anterior descending or left circumflex arteries. Primary angioplasties were performed on the unprotected left main coronary artery. Five patients received direct stenting while the rest had pre-dilatation. Only one patient received Taxus(R) while the rest received Cypher(R) stents.


RESULTS
Of the sixteen patients, eleven developed cardiogenic shock necessitating intra-venous inotropic and intra-aortic balloon counter-pulsation support. Seven perished in hospital (46%); four within the first day while one had a complicated course and perished on the 42nd day of hospitalization. There was no difference in clinical history (hypertension, diabetes, age, and previous coronary intervention) or hemodynamic features (presenting blood pressure, duration of infarct, stent length, and maximum balloon size or pressure) between the two groups. However, the use of inotropes and intra-aortic balloon counter-pulsation (100% vs. 44% p=0.034) was significantly more common in the group which perished. Patient with cardiogenic shock had increased mortality of 63%. Of the nine survivors, one required repeat intervention for subacute stent thrombosis at sixteenth day and one underwent coronary bypass surgery at three months. All remained well up to mean follow up of 420 days.


CONCLUSIONS
Left main coronary artery infarct especially in the setting of cardiogenic shock has a very high mortality rate. Percutaneous intervention can be performed on these patients with minimal delay. In our series, we have shown that primary intervention of the unprotected left main coronary artery with a drug-eluting stent carries an acceptable level of major adverse coronary event. In those who survived the initial event, there is a low rate of mortality or morbidity.
Tan
Chong-Hiok
CH
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Republic of Korea.
Hong
Myeong-Ki
MK
Lee
Cheol-Whan
CW
Kim
Young-Hak
YH
Lee
Chang-Hoon
CH
Park
Seong-Wook
SW
Park
Seung-Jung
SJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003331:Coronary Vessels / Q000473:pathology*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology / Q000628:therapy*