Survival after Acute and Total Occlusion of the Left Main Coronary Artery

Acute total occlusion of the left main coronary artery treated with percutaneous intervention and simultaneous implantation of intra‐aortic balloon pump

“…The optimal revascularization modality (CABG or PCI) for patients with acute total occlusion of the LMCA is still unknown . Emergency PCI of the LMCA with the deployment of DES in high‐risk patients gives results equivalent to that of CABG .…”

“…The optimal revascularization modality (CABG or PCI) for patients with acute total occlusion of the LMCA is still unknown . Emergency PCI of the LMCA with the deployment of DES in high‐risk patients gives results equivalent to that of CABG . Only scarce and inconsistent data have been reported with regard to primary PCI for STEMI due to acute LMCA occlusion .…”

“…Emergency CABG in patients with STEMI complicated by CS may be effective but time‐consuming, and carries the risk of extensive and irreversible myocardial damage . PCI permits rapid reperfusion of the LMCA . PCI seems to be a better choice of treatment than CABG for this special subset of patients with regard to the time to reperfusion.…”

“…As most of the patients with acute occlusion of the LMCA develop a sudden, profound deterioration in hemodynamics, simultaneous efforts to maintain the systemic circulation and to achieve reperfusion of the occluded LMCA as soon as possible are essential for survival . Emergency reperfusion of the LMCA, under stabilizing measures such as the insertion of an IABP, is the primary goal in patients with acute LMCA occlusion . Despite its common use in clinical practice, there is conflicting evidence of the benefit of IABP in CS .…”

Atypical electrocardiographic presentations of myocardial infarction with ST elevation - ST elevation myocardial infarction equivalents

“…Occlusion of the left main coronary artery is a clinical entity that results in the development of acute MI in the anterior or anterolateral region with cardiogenic shock and high mortality rate. Because of the high risk of potential complications and high mortality, early detection of this type of STEMI equivalent and urgent reperfusion is imperative and provides better outcomes [14,15]. ECG criteria are: ST segment elevation in aVR ≥ 1 mm, ST segment elevation in aVR ≥ V1, and diffuse ST segment depression in lateral leads (subendocardial ischemia) [16] (Figure 2).…”