scholarly journals Successful treatment of cardiogenic shock by stenting of the left main coronary artery in acute myocardial infarction

2008 ◽  
Vol 65 (10) ◽  
pp. 769-773
Author(s):  
Bozidarka Knezevic ◽  
Goran Nikolic ◽  
Sinisa Dragnic ◽  
Ljilja Music ◽  
Aneta Boskovic
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Left Main Coronary Artery ◽  
Stable Condition ◽  
Left Main ◽  
St Segment ◽  
Coronary Syndromes

Introduction. Patients with non-ST elevation acute coronary syndromes (NSTE-ACS) are sometimes severely hemodynamicly compromised. Urgent coronary angiography should be performed in these patients in percutaneous coronary intervention (PCI) centers according to the ESC NSTE-ACS guidelines to determine suitabilty for percutaneous or surgical revascularization. Case report. We reported a 62-year-old male with chest pain admitted to the Coronary Care Unit. ST segment depression of 2 mm in leads I, L and V4-6 was revealed at electrocardiogram. After following 6 hours the patient had chest pain and signs of cardiogenic shock despite of the therapy. Chest x-ray showed pulmonary edema. Echocardiographic examination showed dyskinetic medium and apical segments of septum. The patient underwent coronary angiography immediately which revealed 75% stenosis of the left main coronary artery with thrombus. The use of a GPIIb/III inhibitor-tirofiban and stent implantation resulted in TIMI III flow. After that the patient had no chest pain and acute heart failure subsided in the following days Echocardiography done at the fourth day from PCI showed only hypokinesis medium and apical segment of septum. The patient was discharged at day 11 from admission in a stable condition. Conclusion. Stenting of left main coronary artery stenosis in patients with cardiogenic shock and non- ST segment elevation acute coronary syndromes may be a life saving procedure.

scholarly journals Cardiogenic shock in patients presenting with acute left main coronary artery occlusion

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Braga ◽  
J Calvao ◽  
J C Silva ◽  
A Campinas ◽  
A Alexandre ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background and purpose Acute myocardial infarction (AMI) due to left main coronary artery (LMCA) occlusion is a rare event, often catastrophic. Limited data are available about management and outcomes of patients with acute LMCA occlusion, including those presenting with cardiogenic shock (CS) at hospital admission. This study sought to describe patients with AMI due unprotected LMCA occlusion presenting with CS and to evaluate their in-hospital outcomes and 1-year mortality. Methods In this retrospective 2-center study, we identified 7630 patients with ST-segment elevation myocardial infarction (STEMI) or hight risk non-ST segment elevation myocardial infarction who underwent to emergent coronary angiography between January 2008 and December 2020. Among this cohort, we analysed 94 patients who presented with unprotected LMCA occlusion (Thrombolysis In Myocardial Infarction – TIMI ≤2) and divided them in 2 groups according to presence of signs of cardiogenic shock at admission: CS and no-CS. Results Of 94 patients with AMI due LMCA occlusion, 52 patients presented with CS (53.3%). Mean age was 62.8±11.5 years in CS and 62.0±15.9 years in no-CS patients, p=0.766. In both groups, most patients were male. STEMI presentation was more frequent in CS group (80.4% vs. 52.4%, p=0.004). Severe systolic dysfunction of left ventricle was more frequent in CS patients (81.1% vs. 33.3%, p<0.001). Compared to no-CS patients, CS group shown more often TIMI=0 (67.3% vs. 26.2%, p<0.001), collateral coronary circulation Rentrop 0–1 (95.3% vs. 75.0%, p=0.008), and slow-reflow/no-reflow phenomena (30.6% vs 3.8%, p=0.019) in emergent coronary angiography. The need of invasive mechanical ventilation (68.9% vs. 21.4%, p<0.001), and haemodialysis (20.5% vs. 2.4%, p=0.010) were more prevalent in CS patients. Likewise, mechanical circulatory support (MCS) was more frequently used in patients presented with CS (52.9% vs. 26.2%, p=0.009). In subgroup analysis, MCS implantation was not a survival predictor in CS patients (Odds ratio: 3.9 [95% confidence interval: 0.4 to 36.3], p=0.229). Ultimately, in-hospital mortality (78.8% vs. 16.7%, p<0.001) was higher in CS patients. On the other hand, in hospital survivors, there was no significant differences in 1-year mortality (11.1% vs. 23.5%, p=0.42) between both groups. Conclusions Nearly half of patients with AMI due LMCA occlusion presented with CS signs at first medical evaluation. This subgroup of patients had higher in-hospital mortality compared to those without CS, despite MCS implantation. Whether the use of a specific MCS device or whether early use of MCS can change the outcome remains to be elucidated. CS patients who survive to index-hospitalization, had similar long-term outcomes compared to no-CS patients. Further studies are imperative in this population to refine initial medical treatment in order to improve their prognosis. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Lack of Accuracy of the GRACE score to Predict Coronary Anatomy in Acute Coronary Syndromes

2021 ◽  
Author(s):  
Mateus dos Santos Viana ◽  
Thomaz Emanoel Azevedo Silva ◽  
Gabriela Oliveira Bagano ◽  
Bruna de Sá Barreto Pontes ◽  
Milton Henrique Vitoria de Melo ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Coronary Angiography ◽  
Acute Coronary Syndromes ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Coronary Anatomy ◽  
Vessel Disease ◽  
Coronary Syndromes ◽  
Grace Score

ABSTRACTIntroductionCoronary anatomy is one of the strongest risk predictors in Acute Coronary Syndromes (ACS), which justifies early coronary angiography. Diagnostic scores for predicting outcomes are usually superior to clinical judgment. Despite being validated for prognosis, the GRACE score has been used to discriminate patients with high or low probability of anatomical severity.ObjectiveTo test the hypothesis that the GRACE score actually predicts anatomical severity.MethodsThe study was carried out by assessing consecutive patients with ACS who underwent invasive angiography. Severe anatomical disease was defined as obstructive involvement (≥ 70% in diameter) in (1) left main coronary artery or (2) double or triple vessel disease involving proximal left anterior descending artery or (3) subocclusion. The GRACE score was evaluated under numerical and dichotomous tests.ResultsA total of 733 patients were evaluated, aged 63 ± 14 years, 61% male and GRACE score of 119 ± 37. Obstructive coronary disease was observed in 81% of the patients, classified as one, two or three vessel disease, or left main coronary artery involvement in 28%, 23%, 26% and 4%, respectively. The area under the ROC curve of the GRACE score was 0.65 (95% CI = 0.61 - 0.69) for predicting severe disease. The cutoff point below which the first GRACE tertile is defined (109) was used to dichotomize low-risk (N = 318) and medium-high-risk (N = 415) samples. This standard definition of intermediate-high risk by the GRACE score (> 109) revealed sensitivity of 67% in detecting severe anatomy (95% CI = 61% - 72%) and specificity of 50% (95% CI = 46% - 55%), resulting in positive likelihood ratio of 1.3 (95% CI = 1.2 - 1.5) and negative likelihood ratio of 0.66 (95% CI = 0.55 - 0.80). There was a weak correlation between GRACE and anatomical scores such as SYNTAX (r = 0.36, P < 0.001) and Gensini (r = 0.36, P < 0.001).ConclusionDespite statistical association with extent of anatomical coronary disease, the GRACE Score is not accurate to predict severity of disease before coronary angiography.

scholarly journals Aberrant left main coronary artery induced asymptomatic heart failure

2016 ◽  
Vol 3 (4) ◽  
pp. 69
Author(s):  
Bankim Patel ◽  
Aravindan Jeyarajasingam ◽  
Kunal Patel ◽  
Rupen Patel ◽  
Daniel Benatar
Keyword(s):  
Differential Diagnosis ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Left Main Coronary Artery ◽  
Shortness Of Breath ◽  
Coronary Anomalies ◽  
Left Main ◽  
The Right

We report a case of a malignant course of left main coronary artery in a patient presenting with sudden onset chest pain and shortness of breath. The patient is a 44-year-old African American male with a past medical history of hypertension, diabetes mellitus type 2 as well as dyslipidemia presented to the emergency department with non-exertional chest pain radiating to the left arm and shortness of breath. A coronary angiography and CT angiography (CTA) of heart was performed and it demonstrated an aberrant malignant course of the left main coronary artery coming from the right coronary ostium and coursing between the aorta and pulmonary artery. The left ventricular dysfunction was thought to be a consequence of this malignant course. Cardiothoracic surgery was consulted which determined the need for CABG. The incidence of coronary anomalies and patterns in a series of 1,950 angiograms was determined to be 5.64% with the left main coronary artery (LMCA) arising from the right sinus in 0.15% of the angiograms Diagnostic approach for malignant coronary arteries involves coronary angiography and cardiac CT. A widely accepted treatment approach for left main coronary arteries originating from the right sinus is through surgical repair. Our case urges the clinician to expand the differential diagnosis in young to middle age patient presenting with chest pain. In addition, our case reinforces the concept of the detrimental impact of malignant left coronary arteries on cardiac function. This should prompt the physician to consider coronary anomalies as a possible differential diagnosis as part of the evaluation and management of these patients.

VALUE OF ST-SEGMENT ELEVATION IN LEAD AVR IN PREDICTING LEFT MAIN AND OR 3-VESSEL DISEASE IN PATIENTS WITH ACUTE CORONARY SYNDROMES

2017 ◽  
pp. 59-63
Author(s):  
Thanh Hung Dieu ◽  
Anh Vu Nguyen
Keyword(s):  
Predictive Value ◽  
Acute Coronary Syndromes ◽  
Independent Predictor ◽  
Left Main ◽  
St Segment Elevation ◽  
Vessel Disease ◽  
St Segment ◽  
Coronary Syndromes ◽  
Lead Avr ◽  
Sensitivity Specificity

Objects: We assessed the ability of ST-segment elevation in lead aVR to predict left main and/or 3-vessel disease (LM/3VD) in patients with acute coronary syndromes (ACS). Meterial and Method: 410 patients with ACS, who underwent coronary angiography, were evaluated. Results: 131 (31.9%) patients have been LM/3VD. ST segment elevation > 0.05 mV in leads aVR have been an independent predictor LM/3VD with sensitivity, specificity, positive predictive value PPV) and negative predictive value (NPV) 74.0%, 78.1%, 61.4% and 86.5%, respectively (p<0.001). ST segment elevation > 0.05 mV in leads aVR with ST segment depression in leads V4-V6 have related LM/3VD with sensitivity, specificity, PPV and NPV 44.3%, 92.8%, 74.4% and 75.2%, respectively (p<0.001). ST segment elevation > 0.1 mV in leads aVR have related LM/3VD with sensitivity, specificity, PPV and NPV 51.9%, 87.1%, 65.1% and 79.4%, respectively (p<0.001). Conclusions: ST segment elevation > 0.05 mV in leads aVR have been an independent predictor LM/3VD in patients with ACS. Key words: Acute coronary syndromes, ST-segment elevation, aVR

scholarly journals A 44 years-old male patient surviving total occlusion of the left main coronary artery (STEMI) accompanied with cardiogenic shock

2020 ◽  
Vol 60 ◽  
pp. 610-613
Author(s):  
Rasheed K. Ibdah ◽  
Nasr Alrabadi ◽  
Sukaina I. Rawashdeh ◽  
Abdullah Al-Ksassbeh ◽  
Amjad Habeb ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiogenic Shock ◽  
Male Patient ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Total Occlusion
Sign in / Sign up

Export Citation Format

Share Document