eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
Current issue Archive Manuscripts accepted About the journal Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
vol. 14
Original paper

Acute, total occlusion of the left main stem: coronary intervention options, outcomes, and recommendations

István Ferenc Édes, Zoltán Ruzsa, Árpád Lux, László Gellér, Levente Molnár, Fanni Nowotta, Márta Csilla Kerülő, Dávid Becker, Bela Merkely

Adv Interv Cardiol 2018; 14, 3 (53): 233–239
Online publish date: 2018/09/21
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Acute, total occlusion of the unprotected left main stem (uLMo) in acute coronary syndrome (ACS) patients is a catastrophic event often accompanied by sudden cardiac death (SCD) and/or cardiogenic shock (CS) with high mortality rates and limited methods of successful treatment. Emergent, surgical and percutaneous revascularization has been reported before, yet comprehensive data remains scarce.

To examine emergency percutaneous coronary intervention (PCI) outcomes in ACS cases presenting with uLMo.

Material and methods
Data on 23 subjects undergoing primary PCI in uLMo cases were analyzed. The primary end-point was in-hospital death; secondary end-points were successful salvage of coronary anatomy and 90-day major cardiac adverse events (MACE).

About 40% of LM occlusion cases presented following successful on-site cardio-pulmonary resuscitation (CPR). Of all patients arriving for treatment the occluded LM was successfully opened and stented in ~90% of cases. CS was present in > 85% of cases, and circulatory support in the form of intra-aortic balloon pump and/or extracorporeal membrane oxygenation systems was applied in every eligible case (~80%). The in-hospital death rate was 56%, mostly including individuals requiring prior CPR. At 6 months, additional MACE rates were low at 8.7%.

We found that uLMo ACS cases often present with preceding CPR and mostly in manifest CS. Coronary salvage is generally successful, yet uLMo even with optimal present day complex treatment yields quite high mortality rates. This is especially true for patients receiving prior CPR. In surviving patients, however, 6-month MACE rates are acceptable.


acute myocardial infarction/STEMI, left main coronary disease, coronary occlusion, percutaneous coronary intervention

Almudarra SS, Gale CP, Baxter PD, et al. National Institute for Cardiovascular Outcomes Research (NICOR). Comparative outcomes after unprotected left main stem percutaneous coronary intervention: a national linked cohort study of 5,065 acute and elective cases from the BCIS Registry (British Cardiovascular Intervention Society). JACC Cardiovasc Interv 2014; 7: 717-30.
Stone GW, Sabik JF, Serruys PW, et al. EXCEL Trial Investigators. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med 2016; 375: 2223-35.
Mäkikallio T, Holm NR, Lindsay M, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet 2016; 388: 2743-52.
Buszman PE, Kiesz SR, Bochenek A, et al. Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization. J Am Coll Cardiol 2008; 51: 538-45.
Karabulut A, Cakmak M. Treatment strategies in the left main coronary artery disease associated with acute coronary syndromes. J Saudi Heart Assoc 2015; 27: 272-6.
Valeur N, Gaster AL, Saunamäki K. Percutaneous revascularization in acute myocardial infarction due to left main stem occlusion. Scand Cardiovasc J 2005; 39: 24-9.
Emmert MY, Salzberg SP, Felix C, et al. Survival after acute and complete occlusion of left main stem. Asian Cardiovasc Thorac Ann 2010; 18: 315.
Patel N, De Maria GL, Kassimis G, et al. Outcomes after emergency percutaneous coronary intervention in patients with unprotected left main stem occlusion: the BCIS national audit of percutaneous coronary intervention 6-year experience. JACC Cardiovasc Interv 2014; 7: 969-80.
Welsford M, Nikolaou NI, Beygui F, et al. Acute Coronary Syndrome Chapter Collaborators. Part 5: Acute Coronary Syndromes: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2015; 132: S146-76.
Randhawa VK, Nagpal AD, Lavi S. Out-of-hospital cardiac arrest and acute coronary syndromes: reviewing post-resuscitation care strategies. Can J Cardiol 2015; 31: 1477-80.
Larsen JM, Ravkilde J. Acute coronary angiography in patients resuscitated from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation 2012; 83: 1427-33.
Girotra S, Chan PS, Bradley SM. Post-resuscitation care following out-of-hospital and in-hospital cardiac arrest. Heart 2015; 101: 1943-9.
Sakamoto S, Taniguchi N, Nakajima S, et al. Extracorporeal life support for cardiogenic shock or cardiac arrest due to acute coronary syndrome. Ann Thorac Surg 2012; 94: 1-7.
Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) Trial Investigators. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 2013; 382: 1638-45.
Alozie A, Kische S, Birken T, et al. Awake extracorporeal membrane oxygenation (ECMO) as bridge to recovery after left main coronary artery occlusion: a promising concept of haemodynamic support in cardiogenic shock. Heart Lung Circ 2014; 23: e217-21.
Esposito ML, Kapur NK. Acute mechanical circulatory support for cardiogenic shock: the “door to support” time. F1000Res 2017; 6: 737.
Makdisi G, Wang IW. Extra corporeal membrane oxygenation (ECMO) review of a lifesaving technology. J Thorac Dis 2015; 7: E166-76.
Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95: 202-22.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe