Primary percutaneous coronary intervention in an acute myocardial infarction due to the occlusion of the left main coronary artery.

A 75-year-old woman with no prior medical history was admitted to the hospital because of retrosternal pain for six hours, presenting in a state of cardiogenic shock, specifically hypotension, dyspnoea and slight confusion. Her admission ECG showed ST-segment elevation in the anterolateral leads. Having been started on aspirin, clopidogrel, heparin and dopamine, the patient was immediately transferred to the catheterisation laboratory. The coronary angiogram showed total occlusion of the bifurcation of the left main (LM) coronary artery and some collateral flow from the right coronary artery (RCA), the latter itself presenting multiple critical stenoses. Percutaneous coronary intervention (PCI) was performed with deployment of stents at the LM bifurcation, which resulted in the relief of the obstruction, the restoration of the flow in the left coronary artery and the immediate clinical improvement of the patient. The patient left the hospital in good general condition after being treated for ten days and underwent a successful second PCI in the RCA two months later.