A case of acute myocardial infarction due to left main coronary artery occlusion: Case report

RATIONALE: Left main coronary artery (LMCA)-related acute myocardial infarction with cardiogenic shock (CS) carries >80% mortality without immediate revascularization. PATIENT CONCERNS: Thrombolysis often fails in such cases with LMCA and CS, necessitating salvage percutaneous coronary intervention, which typically requires stenting and mechanical circulatory support. DIAGNOSES: LMCA and CS. INTERVENTIONS: We report a unique case successfully managed with drug-coated balloon (DCB)-only angioplasty amid resource constraints during the pandemic. This report presents a high-risk case of LMCA acute myocardial infarction with CS following unsuccessful TNK thrombolysis at the local hospital, successfully revascularized with DCB-only angioplasty without stenting, intravascular ultrasound (IVUS), intra-aortic balloon pump, or extracorporeal membrane oxygenation, because of pandemic-related medical resource limitations (IVUS/intra-aortic balloon pump unavailable) and extracorporeal membrane oxygenation not yet implemented at our hospital at that time. OUTCOMES: Post-procedural TIMI 3 flow was achieved immediately. Postoperatively, the patient's CS gradually resolved. After 1 month, IVUS performed at a tertiary hospital confirmed no need for further intervention for LMCA. Six months later, cardiac function had recovered to normal. LESSONS: This case demonstrates that in resource-limited settings, when safe stent implantation cannot be guaranteed for thrombotic left main occlusion, the DCB-assisted rapid reperfusion strategy may represent a viable, life-saving option. It offers a new approach for primary care hospitals managing such critical emergencies.