How to deal with LM Disease in NSTEMI patient: PCI or CABG?

Lutfi Hafiz Zunardi, Mohammad Saifur Rohman, Budi Satrijo, Adriawan Widiya Nugraha

Abstract


 

Background: The left main coronary artery (LMCA) with acute coronary syndrome have been associated with significant morbidity and mortality. Urgent CABG is recommended for patients with LM disease accompanied by ACS, but requires special preparation and adequate facilities. not all hospitals are ready. PCI on left main coronary artery is a high risk procedure which requires special preparation like IVUS and FFR. Meanwhile, the ACS case is an emergency that needs to be treated immediately. Interventional management is mandatory in this setting, but the concern is whether the action is carried out in an emergency or an elective procedure.

Objective: This study aimed to describe the management of LM disease in NSTEMI patients.

Case presentation: We will discuss a 69-year-old male brought to our hospital because of chest pain while doing moderate activity. The patient was previously referred from a private hospital and was assessed as NSTEACS. from angiography there was Stenosis dd Thrombus at LM, the cardiologist suggest him to be referred to RSSA for CVCU admission and will be underwent Urgent revascularisation. Clopidogrel and aspirin were routinely consumed as dual antiplatelet therapy. We treat the patient with an unfractionated heparin (UFH) bolus, continued with continuous infusion until revascularization. No event of subsequent acute coronary syndrome was observed.

Conclusion: Although the management of patients with LM disease requires some preparation before action is taken, urgent revascularization in Acute coronary syndrome cases must still be carried out immediately.


Keywords


Left Main disease, Percutaneous Coronary Intervention, Acute coronary syndrom, Non ST Elevetion Segment Myocardial infacrtion, Unstable Angina Pectoris, Coronary Artery Bypass Graft Surgery.

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References


Mihajlović D, Maksimović ŽM, Dojčinović B, Banjac N. Acute Coronary Syndrome ( STEMI , NSTEMI and Unstable Angina Pectoris ) and Risk Factors , Similarities and Differences. 2021;(January). doi:10.5937/scriptamed51-27722

Germany GH, Germany AK, Lenzen MJ, Denmark EP, Vranckx P. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST -segment elevation The Task Force for the management of acute myocardial infarction. Published online 2018:119-177. doi:10.1093/eurheartj/ehx393

Kimura K, Kimura T, Ishihara M, Nakagawa Y, Nakao K. JCS GUIDELINES JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome. 2019;83(May):1085-1196. doi:10.1253/circj.CJ-19-0133

Ragosta M. Left Main Coronary Artery Disease_ Importance, Diagnosis, Assessment, and Management. Curr Probl Cardiol. 2015;40(3):93-126. doi:10.1016/j.cpcardiol.2014.11.003

Tanyeli O. Left Main Coronary Artery Disease : Current Treatment Options Left Main Coronary Artery Disease : Current Treatment Options. doi:10.5772/intechopen.71562

Sarma VRSS, Gopalakrishna K, Purnachandra K, et al. A study of unprotected left main intervention in the ACS population 2013 e 2018. Indian Heart J. 2021;73(4):492-496. doi:10.1016/j.ihj.2021.06.010

Karabulut A, Cakmak M. Treatment strategies in the left main coronary artery disease associated with acute coronary. J Saudi Hear Assoc. 2015;27(4):272-276. doi:10.1016/j.jsha.2015.03.002

Kossaify A, Grollier G. Clinical Medicine Insights : Case Reports A Case of Left Main Coronary Artery Disease in an Octogenarian Treated Surgically and Complicated by Myocardial Infarction : Decisions , Techniques , Rescue and Final Outcome. :61-65. doi:10.4137/CCRep.S11542

Damman FAP, Appelman BZY, Vos MVA De, et al. 2020 ESC Guidelines on acute coronary syndrome without ST-segment elevation Recommendations and critical appraisal from the Dutch ACS and Interventional Cardiology working groups. Published online 2021:557-565. doi:10.1007/s12471-021-01593-4

Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289-1367. doi:10.1093/eurheartj/ehaa575

Smith JN, Negrelli JM, Manek MB, Hawes EM, Viera AJ. Diagnosis and management of acute coronary syndrome: An evidence-based update. J Am Board Fam Med. 2015;28(2):283-293. doi:10.3122/jabfm.2015.02.140189

Lorenz CH, Flacke S, Fischer SE. Noninvasive Modalities. Cardiol Clin. 2000;18(3):557-570. doi:10.1016/s0733-8651(05)70161-2

Ramadan R, Boden WE, Kinlay S, Revascularization OU, Drug A. Management of Left Main Coronary Artery Disease. Published online 2018. doi:10.1161/JAHA.117.008151

Alasnag M, Yaqoub L, Saati A, Al-shaibi K. Coronary Left Main Coronary Artery Interventions. Published online 2019:124-130.

Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2011;124(23):2610-2642. doi:10.1161/CIR.0b013e31823b5fee

Li T, Jiang L, Xu L, et al. Interaction Between Treatment and Age or Sex in Non-ST-Segment Elevation Acute Coronary Disease and Three-Vessel Disease. Front Cardiovasc Med. 2022;9(June). doi:10.3389/fcvm.2022.879834

Barssoum K, Kumar A, Rai D, et al. Meta-analysis Comparing Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting for Non-ST Elevation Acute Coronary Syndrome in Patients With Multivessel or Left Main Disease. Curr Probl Cardiol. 2022;47(10):101306. doi:10.1016/j.cpcardiol.2022.101306

Stone GW, Kappetein AP, Sabik JF, et al. Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease. N Engl J Med. 2019;381(19):1820-1830. doi:10.1056/nejmoa1909406

Zwart B, ten Berg JM, van ’t Hof AW, et al. Indications for an early invasive strategy in NSTE-ACS patients. Netherlands Hear J. 2020;28(3):131-135. doi:10.1007/s12471-019-01337-5

Intervention H risk PC. Circulation Cardiovascular Case Series High-Risk Percutaneous Coronary Intervention in the Era of Public Reporting Clinical and Ethical Considerations in the Care of an Elderly Patient With. Published online 2014:258-265. doi:10.1161/CIRCULATIONAHA.113.004604




DOI: https://doi.org/10.21776/ub.hsj.2023.004.02.6

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