Journal of Invasive Cardiology

Cardiogenic shock complicating acute myocardial infarction is associated with high mortality.^1,2 Early recognition and coronary revascularization are crucial to improve its poor prognosis. Successful early reperfusion of the infarct-related coronary artery, while maintaining integrity of the downstream microvasculature, limits ongoing necrosis, salvages myocardium, and may prevent the development of cardiogenic shock.³
In this report we present an unusual case of a patient with acute thrombosis of the left main artery who reached the hospital in cardiogenic shock and underwent emergency percutaneous revascularization. The patient was initially treated with inotropic pharmacological support and intra-aortic balloon counterpulsation. Despite using antithrombotic and antiplatelet therapy, including abciximab, and specific devices to remove thrombus, embolization of thrombus occurred distally with the development of the no-reflow phenomenon. The patient died within a few hours. The management of cardiogenic shock complicating myocardial infarction and intracoronary thrombus is discussed, with an emphasis on the utility of thrombectomy devices.