Acute coronary syndrome due to extrinsic compression of the left main coronary artery in a patient with severe pulmonary hypertension: successful treatment with percutaneous coronary intervention

Objectives. We aim to evaluate long-term outcomes after left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome (ACS). Background. PCI of the LMCA has been an acceptable revascularization strategy in stable coronary artery disease. However, limited studies on long-term clinical outcomes of LMCA PCI in ACS patients are available. Methods. A total of 6429 consecutive patients with ACS undergoing PCI in Fuwai Hospital in 2013 were enrolled. Patients are divided into LMCA group and Non-LMCA group according to whether the target lesion was located in LMCA. Prognosis impact on 2-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed. Results. 155 (2.4%) patients had target lesion in LMCA, while 6274 (97.6%) patients belong to the non-LMCA group. Compared with non-LMCA patients, LMCA patients have generally more comorbidities and worse baseline conditions. Two-year follow-up reveals that LMCA patients have significantly higher rate of cardiac death (2.6% vs. 0.7%, p=0.034), myocardial infarction (7.1% vs. 1.8%, p<0.001), in-stent thrombosis (4.5% vs. 0.8%, p<0.001), and stroke (7.1% vs. 6.4%, p=0.025). After adjusting for confounding factors, LMCA remains independently associated with higher 2-year myocardial infarction rate (HR = 2.585, 95% CI = 1.243–5.347, p=0.011). Conclusion. LMCA-targeted PCI is an independent risk factor for 2-year myocardial infarction in ACS patients.

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A case of acute coronary syndrome caused by extrinsic compression of the left main coronary artery due to pulmonary hypertension

Journal of Cardiology Cases ◽

10.1016/j.jccase.2010.06.002 ◽

2010 ◽

Vol 2 (3) ◽

pp. e154-e158 ◽

Cited By ~ 2

Author(s):

Tomoharu Kawase ◽

Hironori Ueda ◽

Noriaki Watanabe ◽

Chikaaki Motoda ◽

Ryo Takeda ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Left Main Coronary Artery ◽

Left Main ◽

Coronary Syndrome ◽

Extrinsic Compression

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Primary percutaneous coronary intervention for a left main bifurcation lesion without stenting using excimer laser with optical coherence tomography guidance: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa003 ◽

2020 ◽

Vol 4 (1) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Masahiro Hada ◽

Tomoyo Sugiyama ◽

Yoshihisa Kanaji ◽

Tsunekazu Kakuta

Keyword(s):

Optical Coherence Tomography ◽

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Coronary Intervention ◽

Left Main ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Percutaneous Coronary ◽

Bifurcation Lesions

Abstract Background Optimal strategy for treating bifurcation lesions or lesions with large thrombus in left main disease remains elusive. Excimer laser coronary angioplasty (ELCA) is a therapeutic option for thrombotic lesions in acute coronary syndrome. Case summary A 68-year-old man with chest pain was transferred to our emergency department, and subsequently diagnosed as inferior ST-segment elevation myocardial infarction (STEMI). Emergent coronary angiography revealed a 75% stenosis in the left main trunk (LMT). Optical coherence tomography (OCT) showed massive thrombus at the distal LMT to the ostial left anterior descending artery (LAD) and left circumflex artery (LCx). ELCA was performed in the three directions from LMT to proximal LAD, proximal LCx, and obtuse marginal branch. OCT after ELCA showed reduction of thrombus and no apparent plaque rupture or calcification, implying that coronary thrombosis was caused by OCT-defined plaque erosion. Intracoronary electrocardiogram of the LCx showed ST-segment elevation which corresponded to inferior ST-segment elevation, whereas no intracoronary electrocardiogram ST-segment elevation was detected for LAD. Taking all of the data including angiographic appearance, OCT-derived residual lumen size and residual thrombus volume, and strategic options into consideration, we completed percutaneous coronary intervention without stent deployment. He has been free from any cardiac events thereafter for 8 months. Discussion Optimal strategy of coronary intervention for bifurcation lesions, especially LMT bifurcations, remains elusive. ELCA may have a potential to safely reduce intracoronary thrombus in patients presenting with acute coronary syndrome with OCT guidance.

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