Percutaneous Coronary Intervention in Patients with Left Main Coronary Artery Disease and Cardiogenic Shock

Document Type : Original Article

Authors

Department of Cardiology, National Heart Institute, Cairo, Egypt.

Abstract

Introduction: Cardiogenic shock of patients with myocardial infarction still affects between 3-10% of patients, and the in-hospital death rate is <30%. One of the challenges is the left main (LM) coronary intervention.
Objective: The aim of the current study is to investigate the short-term outcome of emergency LM coronary intervention.
Patients and methods: A total of 80 patients who underwent percutaneous coronary intervention (PCI) of LM in the setting of cardiogenic shock in our hospital were retrospectively studied. Short-term clinical outcomes and PCI characteristics were evaluated.
Results: LM was the culprit artery in ]about 62.8% of the patients. The remaining cases were treated due to persistence of cardiogenic shock after successful PCI of the culprit vessel. About 43.6% of the patients had Syntax scores more than 32, and the majority of them had complicated coronary stenosis. Second stent method at the LM bifurcation was employed in 12.8% of cases, complete revascularization in 34.6%, and intra-aortic balloon pump (IABP) in 13.1%. Mortality in hospitals was 48.7%. Half of the patients had no differences between 1 or 2 stent LM bifurcation procedures at 90 days’ follow-up. Patients with incomplete revascularization with a residual Syntax score of 15 or more and those with thrombolysis in myocardial infarction (TIMI) flow.
Conclusion: Neither the use of IABP nor the 2-stent approach in the LM showed a decreased short-term mortality in patients who first presented with cardiogenic shock and LM illness. However, in our study, patients with ultimate TIMI flow <III showed greater short-term mortality.
 

Keywords

The Egyptian Journal of Hospital Medicine
Volume 90, Issue 1
January 2023
Pages 1826-1830

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