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Degree of coronary occlusions links to the patient clinical outcome: four cases of double culprits acute ST-segment elevation myocardial infarction

Dr. Kariadi Central General Hospital, Indonesia

Received: 26 Mar 2021; Revised: 26 Apr 2021; Accepted: 26 Apr 2021; Available online: 30 Apr 2021; Published: 30 Apr 2021.
Open Access Copyright (c) 2021 Journal of Biomedicine and Translational Research

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Background: Double coronary culprit lesions in ST-segment elevation myocardial infarction (STEMI) is uncommon. Despite successful primary percutaneous coronary intervention (PPCI) in all culprit lesions, the clinical outcome remains unfavorable and the possible factors for the outcome are not fully understood.

Cases Presentation: We reported four cases of double culprit lesions STEMI underwent PPCI. Patient A, a 62 y.o. male with extensive anterior-inferior STEMI, had total occlusion (TO) at both proximal left anterior descending (LAD) and mid right coronary artery (RCA). Patient B, a 42 y.o. male with extensive anterior-inferior STEMI, had subtotal occlusion (STO) at proximal RCA and TO at proximal LAD. Both of them had RBBB ECG pattern. Patient C, a 67 y.o. male with inferior STEMI had 90% thrombus occlusion at proximal–mid LAD and TO at proximal RCA. Patient D, a 65 y.o. male with anteroseptal STEMI, had STO at proximal LAD and 80% thrombus occlusion at mid left circumflex. The cardiomyocyte infarction biomarkers increased in all patients. Although all of them underwent successful PPCI in all of culprit lesions, they suffered from acute heart failure and two of them experienced recurrent ventricular arrhythmia episodes. One of them (patient A) died two days post PPCI. He was only patient who suffering from total occlusion in LAD and RCA with TIMI thrombus 5 and experienced a total atrioventricular block post-PPCI.

Conclusion: STEMI with coronary double culprits have severe clinical outcome, regardless of the successful PCI. The degree of coronary occlusions might be linked to the patient clinical outcome. 

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Keywords: ST-segment elevation myocardial infarction; double coronary artery culprits; clinical out-come; degree of coro-nary occlusion

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  1. Ibanez B, James S, Agewall S, Antunes MJ, Bucci-arelli-Ducci C, Bueno H, et al.; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in pa-tients presenting with ST-segment elevation: The Task Force for the management of acute myocardi-al infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177
  2. doi: 10.1093/eurheartj/ehx393.PMID:28886621
  3. van der Wall EE. New guidelines on primary PCI for patients with STEMI: changing insights. Neth Heart J. 2016;24(2):93-5. doi: 10.1007/s12471-015-0780-8.PMID:26645713
  4. Kumar A, Cannon CP. Acute coronary syndromes: diagnosis and management, part I. Mayo Clin Proc. 2009;84(10):917-38. doi: 10.1016/S0025-6196(11)60509-0
  5. PMID: 19797781
  6. Goldstein JA, Demetriou D, Grines CL, Pica M, Shoukfeh M, O'Neill WW. Multiple complex coro-nary plaques in patients with acute myocardial in-farction. N Engl J Med. 2000;343(13):915-22. doi: 10.1056/NEJM200009283431303.PMID:11006367
  7. Rajiv Ananthakrishna, Li-Jun Wang, Liang Ping Zhao, and Huay Cheem Tan.Double jeopardy in acute ST-segment elevation myocardial infarction. Singapore Med J. 2017 Apr; 58(4): 225–227. doi: 10.11622/smedj.2017030
  8. Pollak PM, Parikh SV, Kizilgul M, Keeley EC. Multiple culprit arteries in patients with ST seg-ment elevation myocardial infarction referred for primary percutaneous coronary intervention. Am J Cardiol. 2009
  9. Sep1;104(5):619-23. doi: 10.1016/j.amjcard.2009.04.053
  10. Epub 2009. PMID: 19699333
  11. Rajani AR, Mahmoud WE, Murugesan V, BinBrek AS. The mystery of recurrent idiopathic cerebro-vascular and coronary arterial thrombosis. BMJ Case Rep. 2014 Nov 24;2014:bcr2014205430
  12. Kuzemczak M, Kasinowski R, Skrobich P, Podlewski R, Kalmucki P. A Successfully Treated STEMI Due to Simultaneous Thrombotic Occlusion of Left Anterior Descending Artery and Left Cir-cumflex Artery: A Case Report and Review of the Literature. Cardiol Res. 2018;9(6):395-399. doi: 10.14740/cr798.Epub2018Dec7.PMID:30627293
  13. Sianos G, Papafaklis MI, Serruys PW. Angiograph-ic thrombus burden classification in patients with ST-segment elevation myocardial infarction treated with percutaneous coronary intervention. J Invasive Cardiol2010 Oct;22(10 Suppl B):6B-14B
  14. French JK, Hyde TA, Straznicky IT, Andrews J, Lund M, Amos DJ, et al. Relationship between corrected TIMI frame counts at three weeks and late survival after myocardial infarction. Journal of the American College of Cardiology. 2000;35(6):1516-24
  15. Fukaya H, Oikawa J, Hirasawa S, Shimohama T, Tojo T, Niwano S, Izumi T. Acute myocardial in-farction involving double vessel total occlusion of the left anterior descending and left circumflex ar-teries: A case report. J Cardiol Cases. 2011;4(1):e1-e4. doi: 10.1016/j.jccase.2011.05.002.PMID:30532860;PMCID:PMC6265150
  16. Burke A, Virmani R. Significance of multiple coro-nary artery thrombi. A consequence of diffuse ath-erosclerotic disease? Ital Heart J. 2000;1(12):832-4. PMID: 11152414
  17. Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimat-ani Y, Mitsuba N, et al. Aspiration thrombectomy for acute myocardial infarction resulting from the sequential occlusions of two major coronary arter-ies in a short time. Intern Med. 2004;43(12):1166-70. doi: 10.2169/internalmedicine.43.1166.PMID:15645652
  18. Ribeiro H, Ferreira C, Batista A, Magalhães P, Margato R, Carvalho S, et al. Enfarteagudo do mi-ocárdioduplosequencial [Sequential double vessel myocardial infarction]. Rev Port Cardiol. 2011;30(12):925-7. Portuguese. doi: 10.1016/j.repc.2011.10.001.Epub2011.PMID:22094311
  19. Gershlick AH, Khan JN, Kelly DJ, Greenwood JP, Sasikaran T, Curzen N, et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial. J Am Coll Cardiol. 2015;65(10):963-72. doi: 10.1016/j.jacc.2014.12.038.PMID:25766941;PMCID:PMC4359051
  20. Ducrocq G, Steg PG, Van't Hof A, Zeymer U, Mehran R, Hamm CW, et al. Utility of post-procedural anticoagulation after primary PCI for STEMI: insights from a pooled analysis of the HO-RIZONS-AMI and EUROMAX trials. Eur Heart J Acute Cardiovasc Care. 2017;6(7):659-665.doi: 10.1177/2048872616650869.Epub2016Jun10.PMID:27287251

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