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Strategy for Acute Myocardial Infarction Due To Obstruction of Left Main Trunk of the Left Coronary Artery

Introduction: Recently various catheter interventions (i.e., percutaneous coronary angioplasty (PTCA), stent, etc.) have been used for the treatment of acute myocardial infarction (AMI). Using these interventions, the results of treatment for AMI have improved. However, AMI due to left main trunk of left coronary (LMT) artery often still is fatal. Purpose: To investigate the factors to improve the treatment for cases with obstruction of the main left coronary artery. Methods: We performed coronary artery bypass grafts (CABG) for 593 cases of ischemic heart disease between February 1982 and March 1998. Out of these cases, 74 cases (12.5%) had an AMI. Furthermore, 13 (17.6%) of the AMI cases had obstruction of the LMT. Preoperatively, 11 cases (84.6%) were Forrester Type IV. All of these cases required assistance with an intra-aortic balloon pump (IABP) preoperatively. Eight cases had intervention for and obstructed LMT; two cases had failed PTCA for other portion of the vessel. Results: Early death occurred in six cases (Group D), and there were seven cases in the survival group (Group S). There was one case of right coronary artery (RCA) dominance in Group S. Except for this case, the time to catheter intervention from onset of AMI of Group S was shorter than for Group D. In the three cases in Group D in whom reperfusion of LMT could not be obtained, the time to operation from onset was >6 hours. Conclusion: AMI cases due to LMT obstruction had catheter intervention performed within 2-3 hours from onset, if possible. After that, CABG was needed as early as possible after the patient was assisted by IABP. If intervention was unsuccessful, CABG was needed within four or five hours.