Gilard M, Bouquin V, Boschat J, Provost K, Jobic Y, Larlet J M, Guillo P, Blanc J J
Département de cardiologie, centre hospitalier de la Cavale Blanche, Brest.
Arch Mal Coeur Vaiss. 1997 Sep;90(9):1277-83.
Between 1979 and 1996, 4 acute occlusions of the left main coronary artery (LMC) were treated by primary transluminal coronary angioplasty. They were 4 men with a mean age of 43 +/- 5 years, admitted to hospital less than 8 hours after the clinical onset of symptoms of anterior myocardial infarction in Killip class 4 with complete right bundle branch block on the initial electrocardiogramme. All cases had a previous history of unstable angina over 2 to 15 days. Angioplasty was undertaken immediately in view of the haemodynamic instability. The coronary circulation was of a dominant right coronary type in the 4 cases: significant stenoses were discovered after recanalisation, on the left anterior descending artery (LAD) in 2 cases and the circumflex or marginal arteries in 3 cases. The right coronary artery was atheromatous in all cases but without significant stenosis. Angioplasty was completed by implantation of a stent in 3 cases (LAD : 1 case, LMC : 2 cases). The outcome was rapidly fatal in 3 cases. Only one patient survived 6 months in functional class 3. These results show that myocardial infarction due to occlusion of the left main coronary artery is a very severe condition which justifies rapid recanalisation. Primary angioplasty with stent implantation in an immediate therapeutic option which enables the patient to survive the acute stage, though only in a limited number of cases.
1979年至1996年间，4例左冠状动脉主干（LMC）急性闭塞患者接受了经皮腔内冠状动脉成形术治疗。患者均为男性，平均年龄43±5岁，在前壁心肌梗死临床症状发作后不到8小时入院，Killip分级为4级，初始心电图显示完全性右束支传导阻滞。所有病例在发病前2至15天均有不稳定型心绞痛病史。鉴于血流动力学不稳定，立即进行了血管成形术。4例患者的冠状动脉循环均为右冠状动脉优势型：再通后发现明显狭窄，2例位于左前降支（LAD），3例位于回旋支或边缘动脉。所有病例右冠状动脉均有动脉粥样硬化，但无明显狭窄。3例患者（LAD：1例，LMC：2例）在血管成形术后植入了支架。3例患者预后迅速死亡。仅1例患者存活6个月，心功能分级为3级。这些结果表明，左冠状动脉主干闭塞所致心肌梗死是一种非常严重的疾病，需要迅速再通。急诊血管成形术联合支架植入是一种即时治疗选择，可使患者度过急性期，不过仅适用于少数病例。
