Key result
Thrombotic STEMI follows acute pancreatitis despite normal coronary CT, requiring individualized post-PCI antiplatelets for DIC.
Why the study?
Acute pancreatitis may mimic myocardial infarction, but true coronary thrombosis is less common and management is complicated by disseminated intravascular coagulation after PCI.
Case Report (n=1)
A recent normal coronary CT angiogram does not exclude a later acute thrombotic event, and severe systemic inflammation from acute pancreatitis can trigger both true coronary thrombosis and subsequent DIC.
Answers are grounded in this paper and cite their sources.
Acute pancreatitis may trigger true thrombotic STEMI despite normal prior imaging; hypothesis-generating for thrombotic risk and antithrombotic strategies.
Acute pancreatitis may cause electrocardiographic abnormalities and troponin elevation that mimic acute myocardial infarction.True coronary thrombosis is less common.The development of disseminated intravascular coagulation shortly after percutaneous coronary intervention creates a difficult balance between bleeding control and prevention of early stent thrombosis.A 68-year-old man with no previous pancreatitis presented with acute interstitial pancreatitis.Evaluation did not identify biliary disease, alcohol use, hypertriglyceridemia, hypercalcemia, medication exposure, autoimmune pancreatitis, pancreatic duct abnormalities, or malignancy, and the episode was classified as idiopathic.Coronary CT angiography performed five months earlier had shown an Agatston calcium score of 0 and Coronary Artery Disease Reporting and Data System (CAD-RADS) category 0, with no visible coronary plaque or stenosis.On day two of hospitalization, he developed inferior ST-elevation myocardial infarction caused by a 99% thrombotic subtotal occlusion of the mid-right coronary artery.Primary percutaneous coronary intervention with drug-eluting stent implantation restored normal coronary flow.Approximately 48 hours later, he developed bleeding-predominant disseminated intravascular coagulation with severe thrombocytopenia, hypofibrinogenemia, prolonged coagulation parameters, and mucocutaneous bleeding.Aspirin was continued, ticagrelor was changed to clopidogrel, and targeted blood-component replacement was administered.Acquired and inherited thrombophilia testing performed after recovery was negative.Acute pancreatitis may mimic myocardial infarction, but true coronary thrombosis should be suspected when ischemic symptoms, reciprocal electrocardiographic changes, dynamic troponin elevation, regional wall-motion abnormality, and a culprit coronary lesion are present.A recent normal coronary CT angiogram does not exclude a later acute thrombotic event.Bleeding-predominant disseminated intravascular coagulation shortly after percutaneous coronary intervention requires individualized antiplatelet adjustment and targeted hemostatic support.
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Chamma et al. (2026) conducted a case report in Idiopathic acute pancreatitis, ST-elevation myocardial infarction, disseminated intravascular coagulation (n=1). Percutaneous coronary intervention was evaluated. A 68-year-old man with acute pancreatitis developed a thrombotic STEMI despite a recent normal coronary CT, followed by DIC requiring individualized antiplatelet adjustment after PCI.
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