ACUTE MYOCARDIAL-INFARCTION BY OCCLUSION OF THE LEFT MAIN CORONARY-ARTERY - 4 CASE-REPORTS AND A REVIEW OF THE LITERATURE

Between 1979 and 1996, 4 acute occlusions of the left main coronary ar tery (LMC) were treated by primary transluminal coronary angioplasty. They were 4 men with a mean age of 43 +/- 5 years, admitted to hospita l less than 8 hours after the clinical onset of symptoms of anterior m yocardial infarction in Killip class 4 with complete right bundle bran ch block on the initial electrocardiogramme. All cases had a previous history of unstable angina over 2 to 15 days. Angioplasty was undertak en immediately in view of the haemodynamic instability. The coronary c irculation was of a dominant right coronary type in the 4 cases : sign ificant stenoses were discovered after recanalisation, on the left ant erior descending artery (LAD) in 2 cases and the circumflex or margina l arteries in 3 cases. The right coronary artery was atheromatous in a ll cases but without significant stenosis. Angioplasty was completed b y 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 mont hs in functional class 3. These results show that myocardial infarctio n due to occlusion of the left main coronary artery is a very severe c ondition which justifies rapid recanalisation. Primary angioplasty wit h stent implantation in an immediate therapeutic option which enables the patient to survive the acute stage, though only in a limited numbe r of cases.