Save Life

in Unprotected Left Main Disease

Presenting STEMI with Resuscitated
Cardiac Arrest

KHUON RITHY, Chour SOK

Cardiology Department, Calmette Hospital
SCAI Classification Cardiogenic Shock
Hospital Mortality Rate

A
B
C
D
E
30 days Mortality
Mortality and Readmission in CS Survivors
Cardiogenic shock Revascularization
Strategies

Emergency Revascularization Initial medical Stabilization

Culprit Revascularization Complete Revascularization

Hemodynamic circulation support

Cardiogenic shock Revascularization
Strategies

Emergency Revascularization Initial medical Stabilization

Culprit Revascularization Complete Revascularization

Hemodynamic circulation support

Cardiogenic shock Revascularization
Strategies

Emergency Revascularization Initial medical Stabilization

Culprit Revascularization Complete Revascularization

Hemodynamic circulation support

Cardiogenic shock Revascularization
Strategies

Emergency Revascularization Initial medical Stabilization

Culprit Revascularization Complete Revascularization

Hemodynamic circulation support

Cardiogenic shock Revascularization
Strategies

Emergency Revascularization Initial medical Stabilization

Culprit Revascularization Complete Revascularization

Hemodynamic circulation support

Cardiogenic shock Revascularization
Strategies

Emergency Revascularization Initial medical Stabilization

Culprit Revascularization Complete Revascularization

Hemodynamic circulation support

Cardiogenic shock Revascularization
Strategies

Emergency Revascularization Initial medical Stabilization

Culprit Revascularization Complete Revascularization

Hemodynamic circulation support

Cardiogenic shock Revascularization
Strategies

Emergency Revascularization Initial medical Stabilization

Culprit Revascularization Complete Revascularization

Hemodynamic circulation support

Cardiogenic shock Revascularization
Strategies

Emergency Revascularization Initial medical Stabilization

Culprit Revascularization Complete Revascularization

Hemodynamic circulation support

Improved hemodynamic but no RCTs data show improve outcome
 Case 1
Brief Case Summary
• 74 years old male patient, come to OPD for chest pain with
12 hours onset.

Past Medical History

• Previous MI: No
• Previous PCI: No
• Previous CABG : No
• Atherogenic risk: HTN, active-smoker
 Sudden Cardiac Arrest at OPD
• Resuscitated
• BP: 70/50mmHg, HR: 58bpm
• SpO2: 97% assist ventilated
• Altered consciousness
• Lung: clear
• ABS: metabolic acidosis (pH: 7.23,
HCO3: 17.2, Bcef: -10, PCO2: 40)
• Heart US: LVEF 40-45%
SCAI Shock Stage= CA
AMI-CS
ECG
Final Results
• BP: 96/70, HR: 86bpm
• SpO2: 96% O2 15l/min
• Normal and oriented consciousness SCAI Shock Stage= CA -> BA
• Dyspnea NYHA 2-3
• Urine: 900ml/2H

Discharged on day 7
 Case 2
Brief Case Summary
• 60 years old male patient, hospitalized for severe chest pain
with 3 hours onset.

Past Medical History

• Previous MI: No
• Previous PCI: No
• Previous CABG : No
• Atherogenic risk: active-smoker
ECG
 Clinical Presentation
SCAI Shock Stage= A
• BP: 109/63mmHg, HR: 56bpm
• SpO2: 97% in room air Extended Ant AMI
• Full alerted
• Lung: clear Cardiac Arrest/ VF
• Heart US:
- LVEF 30-35% SCAI Shock Stage= CA
- Elevated LV filling
pressure (type III, IVC: 22mm) AMI-CS
Final Results
• BP: 138/73, HR: 94bpm
• SpO2: 96% in room air
• Normal and oriented consciousness SCAI Shock Stage= CA -> BA
• Lung: clear
• ABS: pH 7.45, HCO3 26, Bcef 2, PCO2: 37

Discharged on day 8
 Take Home Message
• Unprotect LM disease with acute STEMI still poses a significant
challenge to the interventional cardiologist, particularly with
cardiogenic shock and cardiac arrest.
• Knowledge of SCAI shock stage helps stratify risk and select
appreciate approaches- the key to save patient life.
• Optimal stenting selection in unprotected LM disease with
catastrophic event should be assessed and balanced of over the
technical difficulty and risk of side-branch occlusion.
• Provisional stent technic, classic-way, remains the gold standard
technic for this clinical scenario.