Anterior ST‐Segment Elevation From Nondominant Right Coronary Artery Occlusion: Lessons From Two Cases

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Acute nondominant right coronary artery occlusion (n=2). Intervention: Percutaneous coronary intervention. Primary outcome: Resolution of anterior ST-segment elevation and chest pain.

Q: What does this research mean for the field?

Acute occlusion of a nondominant right coronary artery with right ventricular branch compromise can manifest as anterior ST-segment elevation mimicking anterior STEMI, which resolves promptly following successful reperfusion. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hadeel Jameel Ayesh; Mohammad Al-Shaer; Shoukri Alsleibi

doi:10.1155/cric/3860471

January 1, 2026Case Reports in CardiologyOpen Access

Anterior ST‐Segment Elevation From Nondominant Right Coronary Artery Occlusion: Lessons From Two Cases

View Full Paper

Ask AI

Bookmark

Share

Key result

Nondominant RCA occlusion can mimic anterior STEMI, resolving immediately after successful reperfusion.

n=2

Figures

Why the study?

Acute occlusion of a nondominant right coronary artery causing anterior ST-segment elevation is an uncommon cause that may mimic anterior STEMI and complicate culprit vessel identification during emergent angiography.

Key Points

To describe cases of acute nondominant right coronary artery occlusion that presented with anterior ST-segment elevation mimicking anterior STEMI.
Evaluated two patients presenting with anterior ST-segment elevation who underwent emergent coronary angiography (N=2).
Identified the occluded culprit vessel and performed targeted percutaneous coronary intervention and revascularization.
Emergent coronary angiography demonstrated acute occlusion of a nondominant right coronary artery with right ventricular branch compromise in both patients.
Chest pain and anterior ST-segment elevation resolved immediately after right coronary artery reperfusion prior to intervening on nonculprit lesions.
In Case 1, balloon angioplasty restored flow to TIMI 2, while in Case 2, stenting and distal intracoronary drug delivery improved flow from TIMI 0 to TIMI 2.

Study Design

Type

Case Report (n=2)

Structured PICO

P

Population

Two men, aged 58 and 71, presenting with anterior ST-segment elevation mimicking anterior STEMI who underwent emergent percutaneous coronary intervention for acute nondominant right coronary artery occlusion.

I

Intervention

Emergent coronary angiography and percutaneous coronary intervention (PCI) of the non-dominant right coronary artery (NDRCA) culprit lesion (balloon angioplasty in Case 1; drug-eluting stent and intracoronary vasodilators in Case 2), followed by non-culprit vessel PCI.

O

Outcome

Resolution of chest pain, resolution of anterior ST-segment elevation, and restoration of TIMI flow in the culprit vessel.

Acute occlusion of a non-dominant right coronary artery can manifest as an anterior ST-segment elevation myocardial infarction (STEMI) mimic due to isolated right ventricular ischemia, requiring careful angiographic assessment to identify the true culprit vessel.

Limitations

Right-sided precordial leads were not obtained before reperfusion.
Detailed quantitative right ventricular echocardiographic assessment was not performed.
Cardiac magnetic resonance imaging was not performed to independently characterize right ventricular myocardial edema or necrosis.
Intravascular imaging was not performed during treatment of the LAD instent restenosis in Case 1.
No previous ECG was available in Case 1 to establish chronicity of the left bundle branch block.

Implication

Alerts clinicians to consider nondominant RCA occlusion in anterior STEMI; case reports leave open prevalence and require prospective validation.

Abstract

Acute occlusion of a nondominant right coronary artery (RCA) is an uncommon but clinically significant cause of anterior ST-segment elevation that may mimic anterior ST-segment elevation myocardial infarction (STEMI) and pose a diagnostic challenge in identifying the culprit vessel during emergent coronary angiography. We report two patients presenting with anterior ST-segment elevation in whom emergent coronary angiography revealed acute occlusion of a nondominant RCA with right ventricular branch compromise. In both cases, chest pain and ST-segment elevation improved immediately after RCA reperfusion and before intervention on other coronary lesions. These cases highlight the importance of recognizing this atypical presentation and carefully assessing coronary anatomy to identify the culprit vessel and guide timely revascularization.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Ayesh et al. (2026) conducted a case report in Acute nondominant right coronary artery occlusion (n=2). Percutaneous coronary intervention was evaluated on Resolution of anterior ST-segment elevation and chest pain. Acute occlusion of a nondominant right coronary artery can manifest as anterior ST-segment elevation mimicking anterior STEMI, which resolves immediately upon successful reperfusion of the affected vessel.

synapsesocial.com/papers/6ad0fd1915427f6a840404f0 https://doi.org/10.1155/cric/3860471

View Full Paper

Ask AI

Bookmark

Share

Anterior ST‐Segment Elevation From Nondominant Right Coronary Artery Occlusion: Lessons From Two Cases

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Anterior ST‐Segment Elevation From Nondominant Right Coronary Artery Occlusion: Lessons From Two Cases

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading