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Case Reports
. 2025 Aug 27;30(25):104814.
doi: 10.1016/j.jaccas.2025.104814.

Managing Acute Myocardial Infarction in Shock and Anemia

Mehdi Madanchi  1 , Emilie P Belley-Côté  1 , Arushi Bansal  1 , Silvia Maiorano  1 , Michael B Tsang  2
Affiliations
Case Reports

Managing Acute Myocardial Infarction in Shock and Anemia

Mehdi Madanchi et al. JACC Case Rep. .

Abstract

Background: Patients presenting with ST-segment elevation myocardial infarction (STEMI) and concurrent anemia or active bleeding present a therapeutic dilemma.

Case summary: A 61-year-old woman with a history of pulmonary embolism and a newly discovered lung mass presented with inferior STEMI, critically low hemoglobin level, and hemodynamic instability. Coronary angiography revealed thrombotic occlusion of the posterior left ventricular and posterior descending artery. Revascularization was performed using a drug-eluting balloon (DEB)-only strategy.

Discussion: This case illustrates the need for individualized treatment in STEMI patients with cardiogenic shock and high bleeding risk. A DEB-only strategy can be a valuable approach when prolonged antiplatelet therapy is not feasible.

Take home messages: STEMI in anemic patients poses a major diagnostic challenge. Balancing thrombotic and bleeding risk is a common and challenging aspect of STEMI care. In this setting, the use of DEBs can be a viable alternative to stent implantation for patients with active bleeding.

Keywords: acute coronary syndrome; coronary angiography; myocardial infarction.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Madanchi was supported by a research grant from the Swiss National Science Foundation. 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 at Initial Presentation
Figure 2
Figure 2
Initial Angiogram Showing Thrombotic Occlusion of the Posterior Descending Artery and posterior left ventricular Branches
Figure 3
Figure 3
Final Angiogram After Percutaneous Coronary Intervention With the Drug-Eluting Balloon
Visual Summary
Visual Summary
Management of Acute Myocardial Infarction in Shock and Anemia
See this image and copyright information in PMC

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