Simultaneous STEMI and pulmonary embolism in an elderly patient without risk factors can be successfully managed with PCI and triple antithrombotic therapy.
Concurrent STEMI and pulmonary embolism resolved with PCI and DAPT in an elderly patient; leaves open optimal antithrombotic strategy for this rare presentation.
A 73-year-old woman who presented with chest discomfort visited the emergency room. The 12-lead electrocardiography showed ST-segment elevation in II, III, and lead augmented vector foot. Emergent coronary angiography revealed a thrombus in the distal right coronary artery. Percutaneous coronary angioplasty with a stent was performed. After the procedure, persistent dyspnea occurred. Her chest computed tomography (CT) showed occlusion of the bilateral pulmonary artery. We could not find a source for the embolization or a hypercoagulable state. We started a course of dual antiplatelets with oral anticoagulants. Pulmonary embolism was resolved at follow-up chest CT scan. Aspirin, clopidogrel and warfarin were given for 6 months. The patient is doing well now 1 year after the episode.
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Lee et al. (2014) studied this question.
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