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Background: Percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease (ULMCAD) have become a feasible and efficient alternative to coronary artery bypass surgery, especially in patients with acute coronary syndrome (ACS). There is limited data regarding early and late outcomes after ULMCAD PCI in patients with ACS and stable angina.The aim of this study was to compare early and four-year clinical outcomes in patients with ULMCAD PCI presenting as ACS or stable angina in a high-volume PCI center.Methods: We conducted a single center retrospective observational study, that included 146 patients with ULMCAD undergoing PCI between 2014-2018. Patients were divided in two groups: Group A included patients with stable angina (n=70, 47.9%) and Group B patients with ACS (n=76, 52.1%).Results: 30-day mortality was 8.22% overall, lower in Group A (1.43% vs 14.47%, p=0.02). Mortality and major adverse cardiac events (MACE) rates at 4 years were significantly lower in Group A (9.64% vs 33.25%, p=0.001, and 24.06% vs 40.11%, p=0.012, respectively). Target lesion revascularization (TLR) at 4 year didn’t differ between groups (15% in Group A vs 12.76% in Group B, p=0.5).Conclusions: In our study patients with ULMCAD and ACS undergoing PCI had higher early and long-term mortality and MACE rates compared to patients with stable angina, with similar TLR rate at 4-year follow-up.

Rationale:Acute ST-segment elevation myocardial infarction (STEMI) is a rare complication of acute ischemic stroke (AIS) during thrombolytic therapy. We report a case of STEMI occurring 40 minutes after thrombolytic therapy for AIS and discuss the possible mechanisms and therapeutic approaches.Patient concerns:A 87-year-old woman with a history of arterial hypertension was admitted for acute onset of right-sided limb weakness 2 hours before arrival at the emergency department. Forty minutes after intravenous recombinant tissue plasminogen activator (i.v. rtPA) administration for AIS, STEMI occurred (signaled by a third-degree atrioventricular block).Diagnoses:The diagnoses were AIS and STEMI. Coronary angiography confirmed right coronary artery occlusion.Interventions:Four hours after the onset of STEMI, stenting was performed, normalizing the coronary blood flow.Outcomes:The patient died 2 days thereafter because of persistent cardiogenic shock.Lessons:Our case is remarkable owing to the unusually early (<1 hour) occurrence of STEMI after i.v. rtPA administration. A third-degree atrioventricular block after thrombolysis for AIS could signal a STEMI onset. New and ongoing trials are assessing whether adjunct administration of direct thrombin inhibitors of rtPA in the first 24 hours after thrombolysis for AIS can prevent early recurrent ischemic events.

SOUHRNPacienti s těžkou stenózou kmene levé koronární tepny (left main stem, LMS) jsou vzhledem k rozsahu postižení myokardu ve velmi vysokém riziku závažných kardiovaskulárních příhod. Po třech letech dosahuje mortalita farmakologicky léčených nemocných s významnou stenózou LMS 50 %. Za zlatý standard léčby významné stenózy LMS, zvláště při současném postižení několika koronárních tepen, je považován aortokoronární bypass (CABG). Řada studií prokázala, že perkutánní koronární intervence (PCI) může u pacientů pečlivě vybraných týmem kardiologů a kardiochirurgů představovat bezpečnou a účinnou alternativu CABG, s podobnou výslednou mortalitou. Výsledky PCI na LMS se díky neustále dále vyvíjeným technikám PCI a používáním novějších generací lékových stentů trvale zlepšují. Tyto výsledky mohou navíc dále zlepšovat nově zaváděné různé invazivní zobrazovací metody (intravaskulární ultrazvuk nebo optická koherenční tomografi e), případně různé způsoby vyšetření hemodynamických poměrů (frakční průtoková rezerva). Tyto novinky v oblasti PCI LMS mohou v budoucnu vést ke změnám současných doporučených postupů v léčbě postižení kmene levé koronární tepny. ABSTRACTThe patients with severe left main stem (LMS) stenosis have a very high risk of major cardiovascular events because of the extent of ischaemic myocardium. At 3rd year, the mortality rate for patients with signifi cant LMS stenosis treated medically is 50%. Coronary artery bypass grafting (CABG) is considered the gold standard for the treatment of complex LMS stenosis, especially if it is associated with multivessel coronary disease. Many studies have showed that percutaneous coronary interventions (PCI) can be a safe and effi cient alternative to CABG in carefully selected patients by the Heart Team, with similar mortality rates. The LMS PCI results have been continuously improved by the new PCI techniques developed and by the use of newer generation drug eluting stents. Furthermore, different invasive imagistic methods (intravascular ultrasound or optical coherence tomography) or haemodynamic assessment tools (fractional fl ow reserve) can improve the LMS PCI results. With those new developments in the technique of LMS PCI, the current guidelines about the treatment of left main coronary artery disease can be modifi ed in the future. Klíčová slova: Aortokoronární bypass Intravaskulární ultrazvuk Kmen levé koronární tepny Lékový stent Perkutánní koronární intervence Please cite this article as: L.M. Predescu, et al., Current treatment of left main coronary artery disease, Cor et Vasa 58 (2016) e328-e339 as published in the online version of Cor et Vasa available at

Cardiovascular manifestations of tertiary syphilis infections are uncommon, but represent an important cause of mortality and morbidity. Syphilitic aortitis is characterized by aortic regurgitation, dilatation of ascending aorta and ostial coronary artery lesions.We report a case of 36 years old man admitted to our hospital for acute anterior ST segment elevation myocardial infarction complicated with cardiogenic shock (hypotension 75/50 mmHg). Transthoracic echocardiography revealed a dilated left ventricle with severe systolic dysfunction (ejection fraction = 25%), severe mitral regurgitation, moderate aortic regurgitation and mildly dilated ascending aorta. Coronary angiography showed a severe ostial lesion of left main coronary artery which was treated by urgent stent implantation and an intra-aortic contrapulsation balloon was implanted. Blood tests for syphilitic infection were positive. The patient was discharged with treatment including benzathine penicillin.In our case, we present an acute manifestation of a syphilitic ostial left main stenosis treated by primary percutaneous coronary intervention in acute myocardial infarction. Long term follow-up of the patient is crucial as a result of potential rapid in-stent restenosis caused by continuous infection of the ascending aorta.This case is particular because it shows that syphilitic aortitis can be diagnosed in acute settings, like ST segment elevation myocardial infarction.