Emergency angioplasty of totally occluded left main coronary artery in acute myocardial infarction and unstable angina pectoris--institutional experience and literature review.

Acute occlusion of the left main coronary artery (LMCA) is a rare angiographic finding. We report five patients with acute myocardial infarction (AMI) and one patient with unstable angina, in whom reperfusion was achieved or attempted with percutaneous transluminal coronary angioplasty (PTCA). All patients had a long history of stable angina pectoris. The indication for emergency PTCA was cardiogenic shock in the five patients with MI. PTCA was successful in five of six patients. Three patients with reperfusion survived, three died. All survivors underwent coronary artery bypass grafting (CABG) and were still alive at 23 months, 3 and 8 years respectively in NYHA functional class II or III. All patients had a dominant right coronary artery, but only the survivors had moderate or extensive collateralization. Our experience and the literature review indicate that the clinical outcome of patients with acute LMCA occlusion is strongly dependent on the presence or absence of intercoronary collaterals.