Primary stenting for left-main shock syndrome.
OBJECTIVE
Acute myocardial infarction (AMI) complicated by unprotected left-main shock (LMS) remains a highly morbid event among acute coronary syndromes. Whether early percutaneous coronary intervention (PCI) in the stent era improves the clinical outcome remains poorly defined.


RESULTS
25 consecutive patients who presented with LMS were treated by primary stenting of bare metal stents for the unprotected left main lesion with an aid of conventional supportive measures. Mean age of the patients was 67 (range, 46-89), 84% were male, with an initial mean systolic BP of 88mmHg (range, 40-120), HR of 82 bpm (range, 38-130), and symptom onset to reperfusion of 4.8hours (range, 1.5-17). An initial TIMI grade 0 flow was noted on the emergent CAG among 56% of the patients, but after PTCA and stenting, TIMI grade 3 flow was obtained among 84%. 30-day mortality was 32%, while one patient underwent emergent CABG for subacute stent thrombosis and 3 patients required elective CABG for residual disease during admission. Among 11 patients who were discharged alive, one required further institutionalization for ischemic brain injury, and the 2 required target vessel revascularization for restenoses. The major adverse cardiac events (death, re-infarction, stroke, and target vessel revascularization) occurred in 68% (17/25) over a 12-month follow-up, including 40% of mortality.


CONCLUSIONS
AMI complicated by unprotected LMS could be treated effectively with a prompt application of stenting and result in an acceptable mortality and morbidity.
Yamane
Masahisa
M
The Division of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan (M.Y., A.Y., O.K., H.Y.);and the Division of Cardiology, Hino Municipal Hospital, Tokyo, Japan (S.I.).
Inoue
Soushin
S
Yamane
Akiko
A
Kinebuchi
Osamu
O
Yokozuka
Hitoshi
H