Chirumamilla Yashitha, Chinnappan Justine, Alkotob Mohammad Luay
Department of Internal Medicine, Hurley Medical Center, Flint, USA.
Department of Cardiovascular Medicine, Hurley Medical Center, Flint, USA.
Eur J Case Rep Intern Med. 2024 Apr 3;11(5):004495. doi: 10.12890/2024_004495. eCollection 2024.
An acute ST-elevation myocardial infarction (STEMI) followed by reinfarction within a short period of time is typically due to stent thrombosis. However, a STEMI caused by occlusion of one vessel followed by a repeat infarction due to occlusion of a different vessel which was seemingly innocent a few hours earlier is extremely rare. We present the case of a 61-year-old male with a past medical history of prediabetes, hyperlipidemia, tobacco use, and gastroesophageal reflux disease who presented to the emergency department with complaints of chest pain. His initial electrocardiogram (EKG) revealed ST elevation in leads II, III and aVF with reciprocal changes in leads I and aVL. He promptly underwent cardiac catheterization and had percutaneous coronary intervention with placement of two drug-eluting stents (DES) in the right coronary artery (RCA). At that time coronary angiography revealed 50% stenosis of the left anterior descending (LAD) artery and 60% stenosis of the second diagonal branch artery. Shortly after the procedure he was asymptomatic, and the post procedure EKG demonstrated resolution of the ST elevations. However, within 2 hours he developed chest pain and was found to have new ST elevations in the anterolateral leads. Repeat cardiac catheterization revealed patent RCA stents with subtotal occlusion of the LAD and another DES was placed. After the second procedure the patient remained hemodynamically stable, EKG changes resolved, and he was kept on eptifibatide infusion for 18 hours after which he was switched to dual antiplatelet therapy and ultimately discharged home.
Physicians should promptly address the recurrence of symptoms following an initial ST-elevation myocardial infarctions (STEMI) and be proactive regarding follow-up with the appropriate investigations.Although recurrence of STEMI within a few hours is extremely rare, the first 2 weeks following an initial STEMI is a critical time and patients should be educated on symptoms that will require further evaluation.The mortality associated with early recurrent myocardial infarction is up to 50% in 5 years so these patients require strict outpatient follow-up and counseling to minimize risk factors.
急性ST段抬高型心肌梗死（STEMI）后短期内再发心肌梗死通常是由于支架血栓形成。然而，一根血管闭塞导致STEMI，数小时前看似正常的另一根血管随后闭塞又导致再次梗死的情况极为罕见。我们报告一例61岁男性病例，其既往有糖尿病前期、高脂血症、吸烟史和胃食管反流病，因胸痛就诊于急诊科。他的初始心电图（EKG）显示II、III和aVF导联ST段抬高，I和aVL导联有对应性改变。他迅速接受了心脏导管插入术，并在右冠状动脉（RCA）置入了两枚药物洗脱支架（DES）。当时冠状动脉造影显示左前降支（LAD）动脉狭窄50%，第二对角支动脉狭窄60%。术后不久他无症状，术后EKG显示ST段抬高消失。然而，2小时内他又出现胸痛，前侧壁导联发现新的ST段抬高。再次心脏导管插入术显示RCA支架通畅，LAD几乎完全闭塞，又置入了一枚DES。第二次手术后患者血流动力学保持稳定，EKG改变消失，他接受依替巴肽输注18小时，之后改为双联抗血小板治疗，最终出院回家。
医生应及时处理初始ST段抬高型心肌梗死（STEMI）后症状的复发，并积极进行适当的后续检查。虽然STEMI在数小时内复发极为罕见，但初始STEMI后的前2周是关键时期，应告知患者哪些症状需要进一步评估。早期复发性心肌梗死的5年死亡率高达50%，因此这些患者需要严格的门诊随访和咨询，以尽量减少危险因素。
