Ramos Ruben, Patrício Lino, Abreu Ana, Soares Cristina, Mamede Andreia, Fernandes Rita, Gâmboa Paula, Timóteo Ana, Sousa Lídia, Cacela Duarte, Bernardes Luís, Ferreira Rui Cruz
Serviço de Cardiologia, Hospital de Santa Marta, Lisboa, Portugal.
Rev Port Cardiol. 2008 Jul-Aug;27(7-8):965-73.
ST-elevation myocardial infarction (STEMI) with the culprit lesion in the left main artery is a rare cardiac emergency with a poor prognosis.
Review and prognosis evaluation of primary percutaneous coronary intervention (PCI) performed in the setting of STEMI with left main occlusion in a single high-volume center.
Of the 483 primary or rescue PCIs performed and followed in our hospital during a 24-month period (August 2004 to July 2006), we retrospectively evaluated those involving left main procedures and analyzed in-hospital mortality and major cardiac events (MACE) in a 12-month follow-up. We found nine patients, age 68 +/- 9 years, five male, seven with multivessel disease and two with isolated left main disease. Rescue PCI was performed in three patients and primary PCI in the others.
Seven patients presented in cardiogenic shock and two were classified in Killip class II on admission. Inotropic drugs, intra-aortic balloon pump and abciximab were used in eight patients. Drug-eluting stents were used in six patients, bare-metal stents in two, and isolated balloon angioplasty in one. Five patients (55%) died in the hospital and the four discharged home (two of them aged 81 and 82 years) were still alive and free from MACE at 12-month follow-up.
Clinical presentation of STEMI with the culprit lesion in the left main artery was very severe. During PCI, drug-eluting stents, intra-aortic balloon pump and abciximab were used in almost all patients. This entity had a high mortality rate even though primary PCI was performed. Those who survived had a good mid-term prognosis.
罪犯病变位于左主干的ST段抬高型心肌梗死（STEMI）是一种罕见的心脏急症，预后较差。
回顾并评估在单一高容量中心对左主干闭塞的STEMI患者进行的直接经皮冠状动脉介入治疗（PCI）及其预后。
在我们医院24个月期间（2004年8月至2006年7月）进行并随访的483例直接或补救性PCI中，我们回顾性评估了涉及左主干手术的病例，并分析了住院死亡率和12个月随访期内的主要心脏事件（MACE）。我们发现9例患者，年龄68±9岁，5例男性，7例有多支血管病变，2例有孤立性左主干病变。3例患者接受了补救性PCI，其余患者接受了直接PCI。
7例患者出现心源性休克，2例入院时Killip分级为II级。8例患者使用了正性肌力药物、主动脉内球囊泵和阿昔单抗。6例患者使用了药物洗脱支架，2例使用了裸金属支架，1例仅进行了球囊血管成形术。5例患者（55%）在医院死亡，4例出院回家（其中2例年龄分别为81岁和82岁）在12个月随访时仍存活且无MACE。
罪犯病变位于左主干的STEMI临床表现非常严重。PCI期间，几乎所有患者都使用了药物洗脱支架、主动脉内球囊泵和阿昔单抗。即使进行了直接PCI，该疾病的死亡率仍很高。存活者中期预后良好。
