ABSTRACT
Total occlusion of the left main (LM) coronary artery is rare in patients with acute myocardial infarction (AMI). We found published reports describing 5 patients with AMI who by angiography during the first day of presentation had total occlusion of the LM coronary artery. All 5, each of whom had presented with cardiogenic shock, had early intracoronary thrombolytic therapy with opening of the lumen of the LM coronary artery and all survived. Additionally, another reported patient with AMI had total occlusion of the LM coronary artery by angiogram at day 15—but no coronary angiogram or thrombolytic therapy earlier—and this patient was alive 1 year later.4 The present report was prompted by study at necropsy of a patient who survived 54 hours after onset of AMI and who had total occlusion of the LM coronary artery by clot superimposed on atherosclerotic plaque.
