Internal Medicine Department, Mercy Hospital and Medical Center, Chicago, IL, USA.
Am J Emerg Med. 2012 Nov;30(9):2093.e5-8. doi: 10.1016/j.ajem.2011.12.037. Epub 2012 Mar 3.
ST-segment elevation myocardial infarction is usually caused by plaque rupture and subsequent thrombosis of a single culprit vessel. In rare occasions, simultaneous thrombosis of 2 coronary arteries occurs, which is usually associated with a worse prognosis. Although surgery provokes hemodynamic stress, leading in some instances to myocardial ischemia due to supply/demand mismatch, other factors may also contribute to postoperative myocardial infarction. We present a case of postoperative simultaneous left anterior descending and right coronary stent thrombosis that followed cessation of long-term aspirin therapy in a patient with stable coronary artery disease. This case raises concerns with drug-eluting stents due to the higher potential for late stent thrombosis related to delayed endothelialization of the stent struts. Physicians should be very cautious when deciding to withdraw antiplatelet therapy preoperatively to avoid rebound coronary thrombosis.
ST 段抬高型心肌梗死通常由斑块破裂和随后的单一罪犯血管血栓形成引起。在极少数情况下，两条冠状动脉同时发生血栓形成，这通常与预后更差有关。尽管手术会引起血流动力学应激，导致某些情况下由于供需不匹配而发生心肌缺血，但其他因素也可能导致术后心肌梗死。我们报告了一例稳定型冠状动脉疾病患者在停止长期服用阿司匹林治疗后发生的术后左前降支和右冠状动脉支架内血栓形成的病例。由于支架小梁内皮化延迟导致晚期支架内血栓形成的风险增加，这种情况引起了对药物洗脱支架的关注。医生在决定术前停用抗血小板治疗时应非常谨慎，以避免冠状动脉血栓形成的反弹。
