Intraoperative ST-Segment Elevation Myocardial Infarction Complicating Ruptured Abdominal Aortic Aneurysm Repair

BACKGROUND: Acute ST-segment elevation myocardial infarction concurrent with endovascular aneurysm repair for ruptured abdominal aortic aneurysm is an extremely rare and life-threatening emergency, currently lacking unified clinical guidelines for reference. CASE SUMMARY: A 61-year-old male patient underwent endovascular aneurysm repair for ruptured abdominal aortic aneurysm and experienced persistent hypotension during the procedure. Postprocedural electrocardiogram and cardiac enzyme tests confirmed acute ST-segment elevation myocardial infarction. The patient underwent emergency coronary angiography, which revealed severe stenosis, followed by successful balloon angioplasty. The patient recovered and was discharged following multidisciplinary postoperative care. DISCUSSION: This case demonstrates the management principles for multiple life-threatening complications, where the clinical challenge formed by the huge retroperitoneal hematoma (bleeding risk) and the requirement for antiplatelet therapy after urgent revascularization (ischemic risk) was properly addressed. Through accurate identification, precise intervention, and multidisciplinary team collaboration, the patient was successfully rescued. This case provides a referable practical path for clinical decision-making in similar rare scenarios, highlighting the critical value of individualized treatment strategies.