Early occlusion of the non-infarct-related coronary artery following successful primary percutaneous coronary intervention in ST-elevation myocardial infarction

Abstract

We present a clinical case of early occlusion of the non-infarct-related artery (non-IRA) in a patient with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Several hours after successful percutaneous treatment of the occluded right coronary artery the patient developed a second myocardial infarction, which was caused by acute occlusion of the left anterior descending artery, which had a significant lesion in the proximal segment. The lesion was diagnosed during the first catheterization, but was left untreated. We discuss the potential advantages and risks associated with the ad-hoc multivessel PCI strategy in STEMI.

Keywords: ST-elevation myocardial infarction; multivessel percutaneous coronary intervention; non-infarct-related artery.

Figure 1

A – ECG at admission showing ST elevation in inferior wall leads. B – Angiography showing occlusion in the mid segment of the RCA; LAO 60, CRAN 0. C – Good result of primary PCI, LAO 60, CRAN 0. D – Angiography showing significant lesion in the proximal LAD; RAO 10, CRAN 30

Figure 2

A – ECG after recurrence of angina showing inversion of T waves in antero-lateral leads. B – Angiography showing occlusion in the mid-LAD, RAO 40, CRAN 35. C – Good result of PCI of LAD, CRAN 40