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February 28, 2026CureusOpen Access

Simultaneous ST-Elevation Myocardial Infarction and Ischemic Stroke: A Therapeutic Dilemma and a Case for Deferred Revascularization

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Why the study?

Simultaneous acute ischemic stroke and STEMI (cardio-cerebral infarction) represents a challenging emergency with competing therapeutic priorities, and no clear guidelines currently exist to guide management.

Population

One 63-year-old male with simultaneous acute ischemic stroke and inferior STEMI

Design

Case report

Follow-up

One month

Key result

Conservative medical therapy with deferred coronary revascularization improved NIHSS from 17 to 10 and achieved successful PCI after one month in a 63-year-old male with simultaneous acute ischemic stroke and STEMI.

Authors

YDYoussef DaoudiLSLebbar SamyHKHibat Allah Kamri

Discussion

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Overview

Supports stroke-first conservative care with deferred PCI in high-bleeding-risk cases; leaves open broader validation via dedicated trials.

Key Points

  • To address the management challenges of concurrent ST-elevation myocardial infarction and ischemic stroke.
  • Case report of a 63-year-old male with simultaneous STEMI and stroke.
  • Deferral of urgent coronary angiography due to high hemorrhagic risk.
  • Conservative therapy initiated with aspirin and low-molecular-weight heparin.
  • Neurological improvement observed with NIH Stroke Scale scores reducing from 17 to 10.
  • Successful percutaneous coronary intervention achieved after spontaneous coronary reperfusion one month later.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P
Population
1 63-year-old male with uncontrolled hypertension presenting with simultaneous acute ischemic stroke (right middle cerebral artery infarction) and inferior ST-elevation myocardial infarction (cardio-cerebral infarction).
I
Intervention
Initial conservative medical strategy with aspirin (75 mg/day) and enoxaparin (40 mg BID), followed by deferred percutaneous coronary intervention (PCI) with 3 stents one month later.
O
Outcome
Neurological improvement and successful delayed coronary revascularization without hemorrhagic transformation

In patients with simultaneous STEMI and acute ischemic stroke with high hemorrhagic risk, a stroke-first conservative approach followed by deferred PCI may be a safe and effective strategy.

Limitations

  • Single-patient case report with no control group
  • Lack of generalizability due to rarity and individualized approach
  • No randomized evidence supporting delayed revascularization strategy in this context
  • Outcome data limited to one patient and short follow-up
  • Single case report
  • Management strategy remains hypothesis-generating rather than practice-informing

Cite This Study

Daoudi et al. (2026) conducted a case report in 63-year-old male with concurrent acute ischemic stroke (right MCA territory infarction, NIHSS 17) and inferior ST-elevation myocardial infarction (STEMI) with atrial fibrillation (n=1). Conservative medical therapy with aspirin (75 mg/day) and intermediate-dose low-molecular-weight heparin (enoxaparin 40 mg BID) followed by delayed percutaneous coronary intervention (PCI) with 3 stents after one month was evaluated on Neurological improvement measured by NIH Stroke Scale (NIHSS) and functional outcome by modified Rankin Score (mRS); coronary artery patency and clinical stability. Conservative medical therapy with deferred coronary revascularization improved NIHSS from 17 to 10 and achieved successful PCI after one month in a 63-year-old male with simultaneous acute ischemic stroke and STEMI.

synapsesocial.com/papers/69a286720a974eb0d3c01727https://doi.org/10.7759/cureus.104265
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