Key result
A 76-year-old male experienced a second acute myocardial infarction in the left anterior descending artery hours after bare metal stenting of the circumflex artery, which was successfully resolved with a drug-eluting stent.
Case Report (n=1)
This case illustrates the limited ability of angiography alone to determine the site of an acute MI and highlights the importance of clinical judgment and team communication when unexpected events occur during cardiac intervention.
Answers are grounded in this paper and cite their sources.
Clinical judgment beyond angiography is essential in periprocedural MI; this case leaves open optimal imaging and communication strategies.
The first acute myocardial infarction (MI) of an elderly male was determined through angiography to be due to an infarct of the circumflex artery. The angiogram also revealed chronic occlusion and diffuse disease of the left anterior descending artery (LAD). This had been compensated for by collateral circulation from the right coronary artery. Since the patient had no prior history of coronary artery disease, the chronic and collateralized disease of the LAD was presumed to be stable and this artery was not treated. Due to a history of aspirin intolerance a bare metal stent was implanted in the circumflex artery. Within hours after stenting the patient had a second acute MI. Despite no change in the angiogram, the EKG suggested that the LAD was the source of the second MI. Indeed, a drug-eluting stent implanted in the LAD resolved the patient’s signs and symptoms and he was discharged with a favorable outcome. The surprising second MI and the inconsistent stenting illustrate that when the unexpected occurs, there is no substitute for the judgment of a skilled clinician.
No takes yet. Share an insight, caveat, or question.
Allen D. Allen (2012) conducted a case report in Acute myocardial infarction (n=1). Bare metal stent and drug-eluting stent was evaluated on Resolution of signs and symptoms. A 76-year-old male experienced a second acute myocardial infarction in the left anterior descending artery hours after bare metal stenting of the circumflex artery, which was successfully resolved with a drug-eluting stent.
Synapse has enriched 10 related papers. Consider them for comparative context: