Staged medical aid in acute myocardial infarction management as a key for successful treatment of elderly patients with severe comorbidities

During the recent years, since the start of coronary artery stent era not only coronary artery bypass graft surgery, but percutaneous transluminal angioplasty became common in patients with left main coronary artery stenosis. Mechanical complications of myocardial infarction, such as ventricular septal rupture, left ventricle free wall rupture and mitral regurgitation due to papillary muscle rupture, are straight indications for cardiac surgery. However, studies show that the age of over 70 years is a high-risk factor for cardiac surgery. In elderly patients, the duration of cardiopulmonary bypass and aortic cross-clamping time have a major impact on the surgery outcome. Therefore, strategies aimed at reducing the volume of cardiac surgery, should be more successful in elderly patients. On the other hand, elderly patients should be well prepared for surgery, and it should be performed when concomitant diseases are compensated. A case of 82-year patient admitted to the intensive care unit with acute myocardial infarction and chord papillary muscles partial rupture associated with severe mitral regurgitation, is presented. Due to the progression of pulmonary edema, mechanical ventilation was started and emergency percutaneous intervention was administered as a life-saving measure. Stents were placed in obtuse marginal branch, circumflex artery and anterior interventricular artery. Because of existing mitral regurgitation of 3-4 grade, after 2 weeks the patient was re-evaluated ex consilio. Considering relatively stable condition, mitral valve replacement with cardiopulmonary bypass was administered, which was successfully done. The successful treatment of this patient was possible because of the proper and timely staging of the patient’s management.