Key result
Primary PCI successfully treats a patient with STEMI and cardiogenic shock from left main SCAD.
Why the study?
Left main stem spontaneous coronary artery dissection presenting with STEMI and cardiogenic shock is a challenging clinical scenario requiring both successful revascularisation and haemodynamic support.
Case Report (n=1)
Demonstrates successful primary percutaneous coronary intervention in a challenging case of left main stem spontaneous coronary artery dissection presenting with STEMI and cardiogenic shock.
LMS-SCAD with STEMI often triggers cardiogenic shock; Level 5 data leave optimal revascularization and support strategies open.
Spontaneous coronary artery dissection (SCAD) is a rare, but well recognized cause of ST-elevation myocardial infarction (STEMI), especially in middle-aged women with few or no traditional cardiovascular risk factors. Left main stem (LMS) is the culprit coronary artery in around 13 % of STEMI-SCAD patients, and most of these patients develop cardiogenic shock (CS). LMS-SCAD represents a challenging clinical scenario where both successful revascularisation and haemodynamic support are required. Primary percutaneous coronary intervention (PPCI) in LMS-SCAD is a complex procedure, considering the risk of dissection propagation towards the left anterior descending and/or circumflex coronary arteries and in case it cannot be successfully performed, bailout emergent coronary artery bypass grafting may be needed. We herein present the case of a woman with LMS-SCAD who presented with STEMI and CS, illustrating the characteristic angiographic presentation, the treatment with a successful PPCI and the 6-month follow-up with a computed tomography coronary angiogram.
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Kassimis et al. (2025) conducted a case report in Left main stem spontaneous coronary artery dissection (LMS-SCAD) with STEMI and cardiogenic shock (n=1). Primary percutaneous coronary intervention (PPCI) was evaluated. Primary percutaneous coronary intervention was successfully performed in a woman presenting with STEMI and cardiogenic shock due to left main stem spontaneous coronary artery dissection.
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