CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 3, May/June 2022 AFRICA 161 LAD recanalisation was surprisingly difficult, highlighting the severity of the coronary artery disease in this young patient. The LAD recanalisation might be considered a CTO-like procedure, since it necessitated utilisation of a microcatheter and guidewire escalation to cross the occlusion. We ended up with a provisional stenting technique, as recommended by the current European Bifurcation Club.12 Provisional stenting reduces complication rates driven by multi-stenting strategies13 and offers additional ‘bailout’ side-branch stenting if good results are not achieved (> 70% stenosis, TIMI flow < III or dissection > B).14 Conclusion Cardiogenic shock is a major complication of myocardial infarction, particularly in young adults, if not addressed early. Prompt management with rapid diagnosis and revascularisation may help to prevent it and to improve outcomes. However, absolute smoking cessation as well as the avoidance of illicit drug use may be the best prevention in this group of young people. References 1. World Health Organization. The top 10 causes of death. May 2014. http://www.who.int/mediacentre/factsheets/fs310/en/ 2. AroraS, StoufferGA,Kucharska-NewtonAM,QamarA, Vaduganathan M, Pandey A, et al. Twenty year trends and sex differences in young adults hospitalized with acute myocardial infarction. Circulation 2019; 139(8): 1047–1056. 3. Fournier JA, Cabezon S, Cayuela A, et al. Long-term prognosis of patients having acute myocardial infarction when ≤ 40 years of age. Am J Cardiol 2004; 94: 989–992. 4. Babaev A, Frederick PD, Pasta DJ, et al. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. J Am Med Assoc 2005; 294: 448–454. 5. Van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation 2017; 136: e232–e268. 6. Kolte D, Khera S, Aronow WS, Mujib M, Palaniswamy C, Sule S, et al. Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States. J Am Heart Assoc 2014; 3: e000590. 7. Nakazone MA, Tavares BG, Machado MN, Maia LN. Acute myocardial infarction due to coronary artery embolism in a patient with mechanical aortic valve prosthesis. Case Rep Med 2010; 2010: 751857. 8. Cuculi F, Togni M, Meier B. Myocardial infarction due to paradoxical embolism in a patient with large atrial septal defect. J Invasive Cardiol 2009; 21(10): E184–186. 9. Beigel R, Wunderlich NC, Ho SY, Arsanjani R, Siegel RJ. The left atrial appendage: anatomy, function, and noninvasive evaluation. J Am Coll Cardiol Cardiovasc Imaging. 2014; 7(12): 1251–1265. 10. Yang J, Biery D, Singh A, et al. Risk factors and outcomes of very young adults who experience myocardial infarction: the Partners YOUNG-MI registry. Am J Med 2020; 133(5): 605–612. 11. Thiele H, Akin I, Sandri M, de Waha-Thiele S, et al. One-year Outcomes after PCI strategies in cardiogenic shock. N Engl J Med 2018; 379(18): 1699–1710. 12. Lassen JF, Burzotta F, Banning AP, Lefevre T, Darremont O, HildickSmith D, et al. Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club. Euro Interv 2018; 13: 1540–1553. 13. Behan MW, Holm NR, Curzen NP, Erglis A, Stables RH, de Belder AJ, et al. Simple or complex stenting for bifurcation coronary lesions: a patient-level pooled-analysis of the Nordic Bifurcation Study and the British Bifurcation Coronary Study. Circ Cardiovasc Interv 2011; 4: 57–64. 14. Derimay F, Rioufol G, Aminian A, Maillard L, Finet G. Toward a sequential provisional coronary bifurcation stenting technique. From kissing balloon to re-POT sequence. Arch Cardiovasc Dis 2020; 113: 199–208.
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