Coronary artery anomalies presenting with ST-segment elevation myocardial infarction

Abstract

ST-segment elevation MI (STEMI) is a rare presentation in patients with coronary artery anomalies. In these patients, the identification of the culprit lesion and its treatment may be difficult, particularly in the emergency setting of primary percutaneous coronary intervention (PCI). From January 2008 to April 2011, 1015 STEMI patients received coronary artery angiography and primary PCI in our centre. Of these, 5 (0.4%) patients showed a coronary artery anomaly. In this paper we reported two rare cases: i) the first is a single coronary artery originating from right sinus of Valsalva; ii) the second is a separate origin of 3 coronary arteries originating from the right sinus of Valsalva. In conclusion, coronary artery anomalies presenting with STEMI are really uncommon, but often are a challenge. The integration between traditional coronary artery angiography and multidetector computerized tomography is crucial to optimize the interventional and medical management of these patients.

Keywords: coronary artery anomalies; multidetector computerized tomography.; myocardial infarction; primary percutaneous coronary intervention.

Figure 1

Case #1. Coronary artery angiography of single coronary artery. *Anomalous vessel for the middle portion of the anterior interventricular sulcus. Black arrow: probable culprit lesion. White arrow head: anomalous vessel for the proximal portion of the anterior interventricular sulcus.

Figure 2

Case #1. 256-slice electrocardiogram -gated computed tomography of single coronary artery. *anomalous vessel for the middle portion of the anterior interventricular sulcus. Black arrow: probable culprit lesion. White arrow head: anomalous vessel for the proximal portion of the anterior interventricular sulcus.

Figure 3

Case #2. Coronary artery angiography. Red arrow: culprit lesion. *collateral branches for distal segments of culprit vessel.

Figure 4

Case #2. 256-slice electrocardiogram -gated computed tomography showing the relationship between great vessels and coronary arteries and their distribution to myocardial tissue. *anomalous vessel arising from right coronary sinus and running behind pulmonary artery. Arrow head: anomalous vessel with retro-aortic course and culprit lesion.