Sabri Onur ÇAĞLAR, Recai ALEMDAR, Mesut AYDIN, Nurten ERCAN, Enver Sinan ALBAYRAK, Serkan BULUR

Sol Ana Koroner Arter Tıkanıklığına Bağlı Gelişen Akut Miyokard Enfarktüsünde Acil Revaskülarizasyon Stratejileri: 3 Olgu Sunumu

Akut sol ana koroner arter tam tıkanması nadir görülmesine rağmen yüksek ölüm riskitaşımaktadır. Birçok çalışmada sol ana koroner arter lezyonu olan hastalarda koroner işlem ilekoroner by-pass’ın etkinliği karşılaştırılmıştır. Sol ana koroner arterin tam tıkanmasına bağlıolarak ölümcül klinik sonuçlara yol açan ST yükselmeli miyokart infarktüsü’nde henüz kesinbir reperfüzyon seçeneği tanımlanmamıştır. Biz burada ST yükselmeli miyokart infarktüsü ilehastanemize başvuran ve yapılan anjiografide sol ana koroner arter akut tam tıkanmasınıngösterildiği üç hasta örneği sunuyoruz. Hastaların tamamı acil olarak kateterizasyonlabaratuvarına alındı. Hastalardan 1’i revaskülarizasyon amacıyla koroner by-pass’agönderilirken öldü. Bir hasta başvurunun üçüncü günü sistolik pompa sebebiyle öldü. Diğer birhastada perkutan koroner işlem sonrası TIMI III akım sağlandı. Takipleri normal seyreden hastataburcu edildi

Anahtar Kelimeler:

Miyokart infarktüsü, kardiyojenik şok

Emergency Revascularization Strategies In An Acute Myocardial Infarction Due To The Occlusion Of The Left Main Coronary Artery: A Report Of Three Cases

Although acute left main coronary artery (LMCA) occlusion is rare, it carries a very highmortality rate. Several studies have compared the efficacy of elective coronary artery stentingand coronary artery bypass grafting (CABG) in patients with LMCA disease. However, a definitereperfusion modality has yet to be established in ST-elevation myocardial infarction (STEMI)due to acute total occlusion of LMCA, which has catastrophic clinical results. We presentedthree patients with acute anterior STEMI and angiographically documented acute total occlusionof LMCA. All of them were taken to the catheterization laboratory. One patient who was referredto CABG for emergency revascularization died. One died on the 3th day of admission becauseof heart failure.. The other patient, thrombolysis in myocardial infarction (TIMI) III flow wasachieved after percutaneous coronary intervention (PCI), and he was discharged with acceptableshort-term results

Keywords:

Myocardial infarction, cardiogenic shock,

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Silber S, Albertsson P, Avilés FF, et al. Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology: Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J. 2005;26(22):2475-6

Kalbfleisch H, Hort W.Quantitative study on the size of coronary artery supplying areas postmortem. Am Heart J 1977;94(2):183-8.

Marso SP, Steg G, Plokker T, et al.Catheter-based reperfusion of unprotected left main stenosis during an acute myocardial infarction (the ULTIMA experience). Unprotected Left Main Trunk Intervention Multi-center Assessment. Am J Cardiol 1999;83(11):1513-7

Yip HK, Wu CJ, Chen MC, et al.Effect of primary angioplasty on total or subtotal left main occlusion: analysis of incidence, clinical features, outcomes and prognostic determinants. Chest, 2001;120(4):1212–7.

Chauhan A, Zubaid M, Ricci DR, et al. Left main interventionrevisited: early and late outcome after of PTCA and stenting. Cathet Cardiovasc Diagn, 1997;41(1):21–9.

Spiecker M, Erbel R, Rupprecht HJ, Meyer J.Emergency angioplasty of totally occluded left main coronary in acute myocardial infarction and unstable angina pectoris: Institutional experience and literature review. Eur Heart J, 1994;15(5):602–7

Prachar H, Dittel M, Enenkel W. Acute occlusion of left main coronary artery without ventricular damage. Clin Cardiol, 1991;14(2):176–9.

Valle M, Virtanen K, Hekali P, Frick MH.Survival with total occlusion of the left main coronary artery: Significance of the collateral 1979;5(3):269–75. Cathet Cardiovasc Diagn

Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 1999;341(9):687-8.

Sakai K, Nakagawa Y, Kimura T, et al. Primary angioplasty of unprotected left main coronary artery for acute anterolateral myocardial infarction. J Invasive Cardiol 2004;16(11):621-5

Webb JG, Lowe AM, Sanborn TA, et al. SHOCK Investigators. J Am Coll Cardiol. 2003 Oct 15;42(8):1380-6.

Buszman PE, Kiesz SR, Bochenek A, et al. Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization. J Am Coll Cardiol 2008; 66(3):361- 362

Özeke Ö, Ömürlü KY, [Percutaneous Coranary Intervention in Left Main Coronary Artery Disease] Turkiye Klinikleri J Cardiol-Special Topics 2009;2(1):78-90

Quigley RL, Milano CA, Smith LR, White WD, Rankin JS, Glower DD. Prognosis and management of anterolateral myocardial infarction in patients with severe left main disease and cardiogenic shock. The left main shock syndrome. Circulation 1993; 88(5 Pt 2):II65-70.

Yip HK, Wu CJ, Chen MC, et al. Effect of primary angioplasty on total or subtotal left main occlusion: analysis of incidence, clinical features, outcomes, and prognostic determinants. Chest 2001;120(4):1212-7.