Survival of acute ST-elevation myocardial infarction with total occlusion of the left main coronary artery.

This image demonstrates the survival of a patient with total acute occlusion of the left main stem, which was treated by primary percutaneous coronary intervention (PCI). Before the patient was referred to the emergency room, she had already suffered from chest pain for about 11 h. Remarkably, the patient survived the acute myocardial infarction despite extreme myocardial necrosis of >60% of the left ventricle as demonstrated by delayed enhancement MRI. The attached images show angiography before and after PCI, the impressive initial ECG and delayed enhanced MRI with mainly transmural contrast enhancement.