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Case Reports
. 2025 Feb 5;30(3):103094.
doi: 10.1016/j.jaccas.2024.103094.

Deferring Percutaneous Coronary Intervention in Subacute STEMI With Rare Mechanical Complications

Silvia Prosperi  1   2 , Attilio Lauretti  1 , Giada Giumbini  1 , Federico Luongo  1 , Cristiano Miotti  1 , Jasmine Passerini Desideri  1 , Matteo Spreca  1 , Francesco Luigi Rotolo  1 , Francesco Monti  1 , Dario Tino Bertolone  1   3
Affiliations
Case Reports

Deferring Percutaneous Coronary Intervention in Subacute STEMI With Rare Mechanical Complications

Silvia Prosperi et al. JACC Case Rep. .

Abstract

Background: Pseudoaneurysms and walls defects are rare mechanical complications of myocardial infarction, more common in subacute or late presentations.

Case summary: A patient with subacute anterior ST elevation myocardial infarction presented to the emergency department with a large pseudoaneurysm of the apical septum, identified as an ischemic mechanical complication. Despite the confirmed complete occlusion of the left anterior descending artery, revascularization was deferred owing to the patient's high risk.

Discussion: The optimal timing for cardiac surgery in post-ischemic wall mechanical complications remains unclear. Evidence suggests immediate repair may prevent deterioration, while some surgeons recommend delaying surgery for 3 to 6 weeks to allow for fibrotic scar formation, aiding in safer suturing.

Take home message: This case highlights the importance of tailored patient management; the echocardiogram played a crucial role in identifying the optimal treatment strategy for this patient, balancing the risks of immediate intervention against the benefits of delayed surgery.

Keywords: heart rupture subacute; mechanical complications; pseudoaneurysm STEMI.

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Conflict of interest statement

Dr Bertolone is supported by a research grant from the CardioPaTh PhD Program. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Electrocardiogram Sinus rhythm at 84 beats/min with significant ST-segment elevation (3 mm) from V2 to V6.
Figure 2
Figure 2
Transthoracic Echocardiography Reduced left ventricular ejection function (35%) with an apical pseudoaneurysm with hemorrhagic infarction, and a large thrombus (red arrows) attached to the interventricular septum, which partially compressed the right ventricle.
Figure 3
Figure 3
Invasive Coronary Angiography Total occlusion in the proximal segment of the left anterior descending coronary artery.
Visual Summary
Visual Summary
The Critical Role of Echocardiography for Identifying Mechanical Complications of Myocardial Infarction
See this image and copyright information in PMC

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