Ewha Med J.  2015 Oct;38(3):133-137. 10.12771/emj.2015.38.3.133.

Acute Myocardial Infarction Occurred in Multivessel Disease Including Chronic Total Occlusion

• Kim JS
• Yim TH
• Kim BC
• Ju HS
• Gu JJ
• Kim TJ

• KMID: 2171352
• DOI: http://doi.org/10.12771/emj.2015.38.3.133

Abstract

Simultaneous multi-vessel acute myocardial infarction is rare and has poor prognosis. We report a 70-year-old Korean man with an anteroseptal wall ST-elevation myocardial infarction presenting as ventricular tachycardia, sudden cardiac arrest and cardiogenic shock. After successful cardiopulmonary resuscitation, a coronary angiogram revealed three-vessel coronary disease; simultaneous total occlusions of the proximal left anterior descending artery (LAD) and the proximal left circumflex artery (LCX), and chronic total occlusion of the proximal right coronary artery. Primary percutaneous coronary intervention (PCI) of the LAD and LCX was successful and an intra-aortic balloon pump was inserted. Despite the timely and successful PCI result, he died on the 58th day in the hospital due to pneumonia with multiple organ failure.

Keyword

Simultaneous; Coronary occlusion; Myocardial infarction

MeSH Terms

Aged
Arteries
Cardiopulmonary Resuscitation
Coronary Disease
Coronary Occlusion
Coronary Vessels
Death, Sudden, Cardiac
Humans
Multiple Organ Failure
Myocardial Infarction*
Percutaneous Coronary Intervention
Pneumonia
Prognosis
Shock, Cardiogenic
Tachycardia, Ventricular

Figure

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  Fig. 1 Electrocardiogram (ECG). (A) Initial ECG in the emergency room shows ST elevation in aVR and non-specific ST-T change. (B) Six hours later, a sudden pulseless VT is detected. (C) After successful resuscitation, ECG shows ST-segment elevation in the anteroseptal wall.

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  Fig. 2 Chest radiography (A) and chest computed tomography scan (B). These show that both lower lobes had pneumonia.

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  Fig. 3 Initial coronary angiogram. (A) Caudal view of left system angiogram shows total occlusion of the proximal left anterior descending artery (white arrow) and left circumflex artery (black arrow). There is seen diagonal artery (arrow head) with thrombosis in myocardial infarction flow II. (B) Left anterior oblique view of coronary angiogram shows total occlusion of the proximal RCA (arrow).

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  Fig. 4 Coronary angiogram after the intervention. (A) Caudal view of left system angiogram. (B) Left anterior oblique cranial view of coronary angiogram. Successful implantations of everolimus-eluting stent at the proximal left anterior descending artery (white arrow) and the proximal left circumflex artery (black arrow) results in thrombosis in myocardial infarction (TIMI) flow III. Also seen is diagonal artery (arrow head) with TIMI flow II.

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  Fig. 5 Left anterior oblique view of coronary angiogram. Stent implantation is failed as the guidewire could not pass through the right coronary artery lesion.

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