title: Primary percutaneous coronary intervention for acute myocardial infarction secondary to acute left main coronary occlusion in an institution without on-site cardiothoracic surgical support.
abstract: OBJECTIVE
  There is no consensus on the optimal management of acute myocardial infarction due to acute left main coronary occlusion (LMCO). We evaluated the feasibility of primary percutaneous coronary intervention (PCI) for acute LMCO in an institution without on-site cardiothoracic surgical (CTS) support.
  
  
  RESULTS
  We retrospectively identified 20 patients, median age 67 years (range 38 to 81). Sixteen patients presented with cardiogenic shock. All patients required intra-aortic balloon pump counterpulsation and inotropic support. Sixteen patients underwent stenting and four had balloon angioplasty only. Thrombolysis In Myocardial Infarction 3 flow was restored in 13 patients. Post-PCI, six patients were transferred to a tertiary institution for further care: three underwent extracorporeal membrane oxygenation (ECMO), one underwent both ECMO and coronary artery bypass grafting (CABG), one died before ECMO initiation and one stabilised without further intervention. Thirteen patients died in-hospital. There was one subsequent death out of the seven hospital survivors, with median follow-up 390 days (range 60 to 660 days). There was a trend towards survival with a shorter door-to-balloon time (p = 0.07).
  
  
  CONCLUSIONS
  Primary PCI may be a feasible initial revascularisation strategy for acute LMCO in centres without on-site CTS support.
authors.affiliation: Tan Tock Seng Hospital, Department of Cardiology, Singapore. chia1@singnet.com.sg
authors.forename: Pow-Li
authors.initials: PL
authors.lastname: Chia
authors.forename: Brian-Chung-Hoe
authors.initials: BC
authors.lastname: Khoo
authors.forename: Chee-Keong
authors.initials: CK
authors.lastname: Ng
authors.forename: Jimmy-Tien-Wei
authors.initials: JT
authors.lastname: Lim
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D054059:Coronary Occlusion / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015199:Extracorporeal Membrane Oxygenation; D005240:Feasibility Studies; D006297:Health Services Accessibility; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010360:Patient Transfer; D012042:Registries; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents