Complete Revascularization of Simultaneous Acute Occlusion of Three Major Coronary Arteries

J INVASIVE CARDIOL 2020;32(10):E267. 

Key words: acute myocardial infarction, percutaneous coronary intervention

A 65-year-old woman with smoking and hypertension history presented to the emergency department with cardiogenic shock. Acute myocardial infarction (AMI) was diagnosed based on echocardiography, laboratory data (creatine kinase, 244 IU/L), and electrocardiography that indicated ST-segment elevation in lead aVR (Figure 1C), suggesting myocardial infarction caused by multivessel or left main trunk coronary artery disease. Emergency coronary angiography revealed completely occluded mid left anterior descending coronary, proximal left circumflex, and proximal right coronary arteries (Figure 1A). Percutaneous coronary intervention (PCI) was performed with intra-aortic balloon pump support; the floppy guidewire could easily pass through each occlusion, suggesting simultaneous acute occlusion of the three major coronary arteries (SAOT). Moreover, drug-eluting stents were implanted, which improved the coronary flow and stabilized hemodynamics, particularly after complete revascularization (Figure 1B). Although post-PCI laboratory tests showed elevated creatine kinase level (18,000 IU/L) and accompanying severe heart failure, the patient recovered and was discharged 61 days later. Considering the mild elevation in creatine kinase level at admission, this patient fortunately presented to the hospital immediately after the onset of symptoms. AMI caused by SAOT is rarely reported because such severe ischemia can lead to sudden cardiac death. Thus, our case demonstrates that rapid and complete revascularization by PCI can be used to save a patient in such cases.

From the Department of Cardiology, Gunma Chuo Hospital, Gunma, Japan.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted January 8, 2020.

Address for correspondence: Toshihiro Suga, MD, Department of Cardiology, Gunma Chuo Hospital, Kouncho 1-7-13, Maebashi City, Gunma 371-0025, Japan. Email: ss2200@hotmail.co.jp