Percutaneous cardiopulmonary support after acute myocardial infarction at the left main trunk

Abstract

Background: Percutaneous cardiopulmonary support (PCPS) has recently become an accepted modality for the treatment of cardiogenic shock after acute myocardial infarction (AMI). However, the clinical outcomes of patients with AMI at the left main trunk (LMT) undergoing PCPS remain unclear.

Patients and methods: From January 2000 to September 2007, we experienced 16 cases of AMI at the LMT requiring emergent PCPS. The average age ranged from 56 to 74 (mean 68.8), and 13 were male. All cases underwent percutaneous coronary intervention (PCI). The maximum creatine kinase leakage ranged from 6,069 to 22,580 IU/l (mean; 12,880 IU/l). The time to revascularization ranged from 30 min to 1,138 min (mean 229 min). An intra-aortic balloon pumping (IABP) was inserted in all patients.

Results: Among our 16 patients, 10 (62.5%) could be successfully weaned off PCPS, and 6 (37.5%) could be weaned off both PCPS and IABP and discharged. Three patients underwent left ventricular assist system (LVAS) implantation. Two of them, without preoperative severe systemic complications, survived more than 100 days after implantation, whereas the third died perioperatively because of a systemic complication from the preoperative period. Eight patients died of low output syndrome or brain death. Cardiac function did not recover in patients in whom the time to revascularization was more than 4 hours and PCPS support duration more than 3 days.

Conclusions: The clinical outcomes of patients with LMT disease requiring PCPS is not satisfactory. In order to improve clinical outcomes of these patients, a strategy involving a timely insertion of LVAS before the onset of complications might be necessary.