Key result
Percutaneous coronary intervention with two overlapping stents restored TIMI 3 flow from TIMI 1 subtotal mid-LAD occlusion after transient T-wave pseudonormalization and U-wave inversion.
Why the study?
Strict reliance on traditional ST-segment elevation myocardial infarction criteria can miss acute coronary occlusion, making serial ECG comparison particularly important when previously inverted T waves become upright during recurrent symptoms.
Case Report (n=1)
No
This case report demonstrates that transient T-wave pseudonormalization and subtle U-wave inversion during recurrent chest pain can indicate progressive subtotal LAD occlusion even in the absence of traditional STEMI criteria, underscoring the critical need for serial ECG comparison and urgent reassessment.
Serial ECG monitoring may detect progressing mid-LAD occlusion in recurrent pain; case report leaves open prospective validation before practice change.
Background Strict reliance on traditional ST-segment elevation myocardial infarction criteria can miss acute coronary occlusion. Serial comparison is particularly important when previously inverted T waves become upright during recurrent symptoms. Case presentation We report a 70-year-old man with dynamic T-wave alterations and subthreshold ST-segment changes. Initial angiography showed a 95% mid-left anterior descending artery stenosis with Thrombolysis in Myocardial Infarction (TIMI) 2 flow. Immediate percutaneous coronary intervention was recommended but declined after symptom relief despite risk counseling. During recurrent chest pain, transient T-wave pseudonormalization and subtle negative post-T-wave deflections were initially underrecognized. Temporary symptom relief and failure to compare earlier ECGs contributed to continued observation. Medically refractory symptoms and serial ECG changes prompted repeat angiography, which confirmed progression to subtotal occlusion with TIMI 1 flow. Two overlapping stents restored TIMI 3 flow. At 1.5 months, the patient remained asymptomatic, with upright precordial T waves and normal cardiac function on echocardiography. Conclusions This serial ECG–angiographic correlation illustrates the importance of interpreting dynamic repolarization abnormalities alongside symptoms and known coronary anatomy. An apparently improved isolated ECG should not delay urgent reassessment of recurrent ischemia.
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X.F. Steven Zheng (2026) conducted a case report in Recurrent left anterior descending coronary artery ischemia / Non-ST-elevation acute coronary syndrome (n=1). Percutaneous coronary intervention (PCI) with two overlapping stents was evaluated on Coronary blood flow restoration (TIMI flow grade) and clinical symptom resolution. Percutaneous coronary intervention with two overlapping stents restored TIMI 3 flow from TIMI 1 subtotal mid-LAD occlusion after transient T-wave pseudonormalization and U-wave inversion.
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