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
3/2018
vol. 14
 
Share:
Share:
more
 
 
abstract:
Editorial

When the situation almost cannot be worse…

Petr Hájek, Radka Adlová, Josef Veselka

Adv Interv Cardiol 2018; 14, 3 (53): 219–220
Online publish date: 2018/09/21
View full text
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
A 60-year-old man without a history of coronary artery disease presented with ST-elevation myocardial infarction (STEMI). During transportation to the hospital, he developed ventricular fibrillation and later pulseless electrical activity. Chest compressions with an automated mechanical compression–decompression device (aMCD) were initiated. Coronary angiography showed total occlusion of the unprotected left main coronary artery (uLM), and primary percutaneous coronary intervention (PCI) was performed during continuous cardiopulmonary resuscitation (CPR). After the reperfusion, the patient’s heart started to generate effective contractions and aMCD could be discontinued. Return of spontaneous circulation was achieved after 90 min of cardiac arrest. The patient died of cardiogenic shock 11 h later [1].
This is one of several potential clinical scenarios of patients with uLM occlusion. Reperfusion was performed in a timely manner, but the patient still died. What are the causes of such unfavorable progress? Is there any possibility of discovering how to increase the chance of surviving this critical situation?
The authors of the article “Acute, total occlusion of the left main stem: coronary intervention options, outcomes, and recommendations” published in the current issue of “Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej” presented their own experience with this uncommon but often catastrophic event. In a group of 23 patients, they found that these patients frequently experience cardiogenic shock (87%), after or during CPR (52%), and even with a procedural success rate of 91%, the in-hospital and 6-month mortality rates were high (57% and 65%, respectively).
Patients with uLM lesions represent a subgroup of acute coronary syndrome patients with the largest amount of jeopardized myocardium. They therefore have higher mortality and a higher probability of developing cardiogenic shock. In a meta-analysis of a group of 977 patients with PCI for acute myocardial infarction (AMI) due to uLM disease, 26% of patients were in cardiogenic shock. The 30-day mortality rate was 55% and 11%, respectively, for those with or without cardiogenic shock [2].
Severe hemodynamic instability of patients with uLM occlusion can result in the necessity for CPR before or during PCI. Type and length of CPR influences performance of the revascularization procedure. A mechanical chest compression device...


View full text...
references:
Stechovsky C, Hajek P, Cipro S, Veselka J. Mechanical chest compressions in prolonged cardiac arrest due to ST elevation myocardial infarction can cause myocardial contusion. Int J Angiol 2016; 25: 186-8.
Vis MM, Beijk MA, Grundeken MJ, et al. A systematic review and meta-analysis on primary percutaneous coronary intervention of an unprotected left main coronary artery culprit lesion in the setting of acute myocardial infarction. JACC Cardiovasc Interv 2013; 6: 317-324.
Štěchovský C, Hájek P, Cipro Š, Veselka J. Risk of myocardial contusion in cardiac arrest patients resuscitated with mechanical chest compression device. Int J Cardiol 2015; 182: 50-1.
Lee MS, Dahodwala MQ. Percutaneous coronary intervention for acute myocardial infarction due to unprotected left main coronary artery occlusion: status update 2014. Catheter Cardiovasc Interv 2015; 85: 416-20.
Hajek P, Alan D, Vejvoda J, et al. Treatment of a large left main coronary artery thrombus by aspiration thrombectomy. J Thromb Thrombolysis 2009; 27: 352-4.
Jolly SS, Cairns JA, Yusuf S, et al. Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial. Lancet 2016; 387: 127-35.
Rab T, Sheiban I, Louvard Y, et al. Current interventions for the left main bifurcation. JACC Cardiovasc Interv 2017; 10: 849-65.
Heusch G, Gersh BJ. The pathophysiology of acute myocardial infarction and strategies of protection beyond reperfusion: a continual challenge. Eur Heart J 2017; 38: 774-84.
Atkinson TM, Ohman EM, O’Neill WW, et al. Interventional Scientific Council of the American College of Cardiology. A practical approach to mechanical circulatory support in patients undergoing percutaneous coronary intervention: an interventional perspective. JACC Cardiovasc Interv 2016; 9: 871-83.
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe