Acute Myocardial Infarction Due to Left Main and Left Circumflex in Patient Have Damage to Triple Vessel Coronary Artery with Chronic Total Occlusion of the Right Coronary Artery: Coronary Artery Bypass Grafting or Percutaneous Coronary Intervention?

Abstract

Objective: To study a case of myocardial infarction due to left main (Lm) and left circumflex (LCx) of the left coronary artery (LCA) on the background of severe damage to triple vessel coronary artery with Chronic Total Occlusion (CTO) of the right coronary artery (RCA) have indications and decisive choice the most optimal to ensure safety and effectiveness.

Methods: Clinical case report and literature review. Study of one case of myocardial infarction caused by Lm and LCx of the LCA with CTO of the RCA on the background of severe damage to triple vessel coronary artery with an old myocardial infarction having 3 stents placed at the Vietnam National Heart Institute in 2016, indicated for PCI of the left coronary artery (LCA) or coronary artery bypass grafting (BCAG) or CTO intervention of the RCA. The decision to choose the Lm and LCx percutaneous coronary intervention (PCI).

Results: An 83-year-old male patient was admitted to the Vietnam National Heart Institute in August 2023 for myocardial infarction due to Lm and LCx of the LCA. Medical history of 3 vessel coronary artery disease (CAD) with an old myocardial infarction having 3 stents placed including the LAD and LCx intervention as well as CTO intervention of the RCA in 2016 on the background of atrial fibrillation, heart failure, hypertension and dyslipidemia. Solved the patient has indicated for PCI intervention as well as CABG or CTO intervention. The decision made was to perform PCI intervention of the Lm and LCx based on individual analysis and the patient's condition. The results of the PCI intervention in the case were safe and successful.

Conclusions: The decision to choose the PCI intervention or coronary artery CTO intervention or BCAG method for each individual in each patient situation is very important, it is necessary to come up with a reasonable and timely plan with the primary goal of improving the patient's prognosis, symptoms, and quality of life. With today's medical advances and the interventional experience of doctors, coronary artery CTO intervention or BCAG has become more widely indicated, but requires strategy, careful preparation, and advanced techniques in surgery or CTO intervention.