Successful Percutaneous Revascularization for Acute Myocardial Infarction From Left Main Occlusion and Concomitant Right Coronary Artery Chronic Total Occlusion: A Case Report

Abstract

Despite its rarity, acute occlusion of the left main coronary artery is associated with an exceedingly high mortality rate. This report describes a critical case of acute myocardial infarction (AMI) caused by acute total occlusion of the left main (LM) artery, complicated by a chronic total occlusion (CTO) of the proximal right coronary artery (RCA). A 55-year-old Chinese male with hypertension and a heavy smoking history presented with sudden chest pain. The initial electrocardiogram (ECG) showed ST-segment elevation in leads V1–V6 and aVR, indicative of anterior wall AMI, and the patient was in cardiogenic shock. Emergency coronary angiography revealed total occlusion of the LM artery and a CTO of the proximal RCA. Primary percutaneous coronary intervention (PCI) was successfully performed on the LM artery, with three stents implanted to restore TIMI grade 3 flow. An intra-aortic balloon pump (IABP) was inserted for circulatory support. Post-procedurally, the patient experienced ventricular fibrillation but was successfully resuscitated. The hospital course was complicated by acute renal failure, gastrointestinal bleeding, and severe sepsis. After 55 days of intensive care, the patient was discharged with marked clinical improvement, albeit with severely impaired left ventricular function (ejection fraction 25%). The patient survived at the 6-month follow-up.