A case report: reflections on the formation of acute thrombotic events after PCI in patients with acute ST-Segment elevation myocardial infarction

Jiaqiang Yang; Jiaru Yang; Haigang Huang; Jing Wei; Puyue Tang

doi:10.1186/s12245-025-01103-y

December 23, 2025International Journal of Emergency MedicineOpen Access

A case report: reflections on the formation of acute thrombotic events after PCI in patients with acute ST-Segment elevation myocardial infarction

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Key result

Acute thrombosis follows emergency PCI for STEMI within 30 minutes in a case report.

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Why the study?

Platelet gene resistance may result in acute thrombosis, but clinical reports are scarce.

Key Points

To present a case of hyperacute in-stent thrombosis following emergency percutaneous coronary intervention in a patient with acute ST-segment elevation myocardial infarction and examine diagnostic and management strategies.
A 57-year-old male with acute anterior ST-segment elevation myocardial infarction received 300 mg aspirin and 600 mg clopidogrel prior to emergency coronary angiography.
Primary percutaneous coronary intervention was performed with intravascular ultrasound guidance and placement of a 3.5 × 24 mm everolimus-eluting stent in the occluded left anterior descending artery, supplemented by local tirofiban and recombinant tissue plasminogen activator.
Acute in-stent thrombosis and total vessel re-occlusion developed 30 minutes postoperatively, manifesting as recurrent chest pain and ST-segment re-elevation unresponsive to sublingual nitroglycerin.
Emergency repeat angioplasty with intracoronary prourokinase and tirofiban eliminated visible in-stent thrombus and restored distal perfusion to TIMI grade 3.
Pharmacogenetic testing revealed platelet resistance related to clopidogrel metabolism, confirming a biological risk factor for hyperacute stent thrombosis.

Structured PICO

P

Population

1 57-year-old Han Chinese male presenting with acute ST-segment elevation myocardial infarction (STEMI).

I

Intervention

Emergency percutaneous coronary intervention (PCI) with a 3.5 × 24 mm everolimus-eluting stent, followed by repeat PCI with intracoronary prourokinase and tirofiban for acute in-stent thrombosis, and switching from clopidogrel to ticagrelor based on genetic testing.

Implication

This case highlights the importance of considering clopidogrel resistance and utilizing genetic testing in patients who develop acute in-stent thrombosis after PCI for STEMI.

Abstract

Platelet gene resistance may result in acute thrombosis, although clinical reports are scarce.This article presents a classic case of acute in-stent thrombosis and discusses its diagnostic and therapeutic strategies.The patient, a 57-year-old male, was admitted due to chest pain that lasted for one hour. After a thorough examination, he was diagnosed with acute ST-segment elevation myocardial infarction. Acute thrombosis rapidly occurred within 30 minutes following emergency coronary stent implantation.

Discussion

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Cite This Study

Yang et al. (2025) studied this question. Acute thrombosis occurred within 30 minutes after emergency coronary stent implantation in a 57-year-old male with ST-segment elevation myocardial infarction.

synapsesocial.com/papers/6963222d91e05aa366cb8bcd https://doi.org/10.1186/s12245-025-01103-y

Topics

STEMI management

Percutaneous coronary intervention

Chronic total occlusion PCI

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A case report: reflections on the formation of acute thrombotic events after PCI in patients with acute ST-Segment elevation myocardial infarction

Figures

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Topics

A case report: reflections on the formation of acute thrombotic events after PCI in patients with acute ST-Segment elevation myocardial infarction

Figures

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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