Introduction: Medical therapy alone often insufficiently alters the clinical course of patients who have experienced acute myocardial infarction and concomitant cardiogenic shock, and in whom the left main coronary artery (LMCA) is involved. Urgent coronary angiography should be performed in these patients in percutaneous coronary intervention (PCI) centers according to the ESC guidelines to determine suitability for percutaneous or surgical revascularization.
Case presentation: We reported a 62-year-old wo-men with chest pain admitted to the Coronary Care Unit with acute AMI and cariogenic shock. She had on admission a left bundle branch block on ECG with positive troponine, signs of cardiogenic shock despite of the medical therapy. Echocardiographic examina-tion showed dilatation of left ventricle, ejection frac-tion of 30% with severe motion disorder. The patient underwent coronary angiography immediately which revealed 75-90% stenosis of distal part of the left main coronary artery, occlusion in medium part of left des-cending artery, proximal occlusion of right coronary artery. The cardiac surgeon contraindicated the surgery because of high risk of intervention. We performed stent implantation in left main coronary artery (two stent strategy) with good angiographic result. After that the patient had no chest pain and acute heart failure subsided in the following days. The patient was dis-charged at day 10 from admission in a stable condition.
Conclusions: Stenting of left main coronary artery ste-nosis in patients with cardiogenic shock and AMI may be a lifesaving procedure despite procedural difficulties and complication.