Recurrent coronary spasm presenting as acute STEMI; To stent or not to stent?

Coronary artery spasm is a relatively uncommon cause of ST segment elevation myocardial infarction. However, the clinical presentation and electrocardiographic findings are remarkably similar to STEMI secondary to plaque rupture. Recurrent presentation with coronary vasospasm as STEMI presents a unique clinical dilemma especially if they present to different centers where the previous history is not well known. Management in the acute settings continue to pose significant challenges in these acutely unwell patients. We describe and explore a similar clinical situation in which a patient with severe recurrent STEMI presentations was found to have coronary artery vasospasms. The case was twice misinterpreted as having plaque rupture STEMI leading to percutaneous coronary intervention and then further difficulties in long term management in view of need for long term antiplatelet and suspected association of eosinophilia with coronary vasospasm which in turn can be caused by Aspirin.