Successful treatment of cardiogenic shock by stenting of the left main coronary artery in acute myocardial infarction.
BACKGROUND
Patients with non-ST elevation acute coronary syndromes (NSTE-ACS) are sometimes severely hemodynamicly compromised. Urgent coronary angiography should be performed in these patients in percutaneous coronary intervention (PCI) centers according to the ESC NSTE-ACS guidelines to determine suitabilty for percutaneous or surgical revascularization.


METHODS
We reported a 62-year-old male with chest pain admitted to the Coronary Care Unit. ST segment depression of 2 mm in leads I, L and V4-6 was revealed at electrocardiogram. After following 6 hours the patient had chest pain and signs of cardiogenic shock despite of the therapy. Chest xray showed pulmonary edema. Echocardiographic examination showed dyskinetic medium and apical segments of septum. The patient underwent coronary angiography immediately which revealed 75% stenosis of the left main coronary artery with thrombus. The use of a GPIIb/III inhibitor-tirofiban and stent implantation resulted in TIMI III flow. After that the patient had no chest pain and acute heart failure subsided in the following days Echocardiography done at the fourth day from PCI showed only hypokinesis medium and apical segment of septum. The patient was discharged at day 11 from admission in a stable condition.


CONCLUSIONS
Stenting of left main coronary artery stenosis in patients with cardiogenic shock and non-ST segment elevation acute coronary syndromes may be a life saving procedure.
Knezević
Bozidarka
B
Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro. cicacg@cg.yu
Nikolić
Goran
G
Dragnić
Sinisa
S
Musić
Ljilja
L
Bosković
Aneta
A
D003331:Coronary Vessels; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000209:etiology*; D015607:Stents; D015912:Thrombolytic Therapy; D000077466:Tirofiban; D014443:Tyrosine / Q000031:analogs & derivatives / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D014443:Tyrosine; D000077466:Tirofiban