Key result
Intracoronary streptokinase (250,000 units) opened a completely obstructed left anterior descending artery, revealing a 90% obstruction, though an anterior myocardial infarction still occurred.
Case Report (n=1)
This case demonstrates that an acute myocardial infarction can be caused by thrombosis at the site of a minor coronary irregularity, occurring in a near-normal coronary artery.
Supports thrombosis on minor irregularities as MI trigger; hypothesis-generating and should not change practice.
Myocardial infarction is usually caused by a thrombus occurring on a significant coronary lesion. A 60-year-old male was admitted with an acute evolving anterior myocardial infarction. Three hours after the beginning of chest pain, the electrocardiogram showed ST-segment elevation in the anterior and lateral leads which persisted despite intravenous nitroglycerin (100 mcg/min). One hour later, an angiogram showed complete obstruction at the origin of the left anterior descending artery (LAD). After intracoronary streptokinase (250,000 units) the LAD opened and a 90% obstruction was seen at its origin. However, an anterior myocardial infarction occurred. One month later, an angiogram showed a slight irregularity at the origin of the LAD. Thus, this case demonstrates that 1) a myocardial infarction may occur with a near normal coronary artery, and 2) a thrombus may occur at the site of a slight coronary irregularity.
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Gagnon et al. (1982) conducted a case report in acute evolving anterior myocardial infarction (n=1). intracoronary streptokinase was evaluated. Intracoronary streptokinase (250,000 units) opened a completely obstructed left anterior descending artery, revealing a 90% obstruction, though an anterior myocardial infarction still occurred.
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