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European Heart Journal 1994 15(5):602-607;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Emergency angioplasty of totally occluded left main coronary artery in acute myocardial infarction and unstable angina pectoris—institutional experience and literature review

M. SPIECKER, R. ERBEL*, H.-J. RUPPRECHT and J. MEYER

II. Medical Clinic, University of Mainz Germany
*Department of Cardiology, University of Essen Germany

Received 22 September 1993; revised 20 January 1994; .

Correspondence. Dr Martin Spiecker, II. Medical Clinic, University of Mainz, Langenbeckstrae 1, D-55101 Mainz, Germany

Abstract

Acute occlusion of the left main coronary artery (LMCA) is a rare angiographic finding. We report five patients with acute myocardial infarction (AMI) and one patient with unstable angina, in whom reperfusion was achieved or attempted with percutaneous transluminal coronary angioplasty (PTCA). All patients had a long history of stable angina pectoris. The indication for emergency PTCA was cardiogenic shock in the five patients with MI. PTCA was successful in five of six patients. Three patients with reperfusion survived, three died. All survivors underwent coronary artery bypass grafting (CABG) and were still alive at 23 months, 3 and 8 years respectively in NYHA functional class II or III. All patients had a dominant right coronary artery, but only the survivors had moderate or extensive collateralization. Our experience and the literature review indicate that the clinical outcome of patients with acute LMCA occlusion is strongly dependent on the presence or absence of intercoronary collaterals.

Key Words: Left main coronary artery occlusion • infarct percutaneous transluminal coronary angioplasty • collateral circulation • myocardial infarction surgery


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