Impella^®-Assisted Revascularization of Unprotected Left Main Coronary Artery-Acute Myocardial Infarction Leading to Cardiogenic Shock

Abstract

Unprotected left main trunk coronary artery-acute myocardial infarction (ULMCA-AMI) causes extensive myocardial damage and leads to cardiogenic shock (CS), which is associated with pump insuffi ciency. Although coronary angioplasty has improved the survival rate of acute myocardial infarction (AMI), management of ULMCA-AMI is complicated.Impella ® (Abiomed, Danvers, MA, USA) is a recently introduced percutaneously inserted left ventricular (LV) assist pump that has been shown to have efficacy in treating CS, including CS due to AMI [1][2][3] . Impella ® maintains hemodynamic stability and reduces the LV end-diastolic pressure (LVEDP ; LV unloading). In addition, it is expected to reduce infarct size 4) and prevent LV remodeling by reducing the cardiac load. Therefore, Impella ® support during revascularization surgery for AMI avoids circulatory failure and enables cardiac rest, improving the postoperative survival and maintenance of the cardiac function. A similar effi cacy is expected in ULMCA-AMI.We herein report our experience with Impella ® -assisted coronary angioplasty in three patients with ULMCA-AMI. Case reports Case 1An 82-year-old man with a history of endovascular stent placement for abdominal aortic aneurysm was brought to our hospital for sudden chest pain. His blood pressure (BP) was 120/58 mmHg, heart rate was 95 bpm, and arterial oxygen saturation (SpO 2 ) was 98% with supplemental O 2 of 10 L/min via a mask. The 12-lead electrocardiogram (ECG) showed ST-T elevation in leads I, aVL, and V2-6, and ST-T depression in leads II, III, and aVF (Fig. 1A). Transthoracic echocardiography (TTE)