Tang HC, Wong A, Wong P, Chua TSJ, Koh TH, Lim ST
Correspondence: Dr Tang Hak Chiaw, tang_hak_chiaw@nhc.com.sg
ABSTRACT
Introduction Acute myocardial infarction (AMI) due to left main coronary artery (LMCA) occlusion carries a grave prognosis. Large series reporting on the outcome of emergency revascularisation (percutaneous or surgical) of acute LMCA occlusion have been scarce. We seek to identify, in our local population, the clinical presentation and outcome of this group of patients.
Methods From January 2000 to December 2005, a total of 1,539 patients underwent primary percutaneous coronary angioplasty for AMI in our institution. 11 patients (0.8 percent) underwent percutaneous intervention to the LMCA. These patients became the subjects of our study. Data on demography, clinical features and outcome was collected from all in-hospital and clinical notes. One sub-investigator, who was blinded to the study outcome, assessed the angiographical features.
Results The overall inpatient mortality was 82 percent (9 out of 11). Nine out of 11 patients presented with cardiogenic shock. All patients presented with shock died during the hospital stay. All patients required intra-aortic balloon counter pulsation insertion. Of the two patients who survived till discharge, one had angioplasty followed by bypass surgery. The remaining one had angioplasty and stenting to the left main artery. Both survivors have been doing well without further major adverse cardiac event after an average of 64 months of follow-up.
Conclusion Percutaneous revascularisation of acute LMCA occlusion is feasible and the best outcome is seen in stable patients. Prognosis is still poor in patients with unfavourable clinical features.
Keywords: acute myocardial infarction, emergency coronary revascularisation, intra-aortic balloon counter pulsation, left main coronary artery occlusion, primary percutaneous coronary angioplasty
Singapore Med J 2007; 48(12): 1122–1124
