Guarnieri Gianluca, Mele Daniela, Briguglia Daniele, Medda Massimo, Conte Edoardo, Bartorelli Antonio, Andreini Daniele
Department of Biomedical and Clinical Sciences, University of Milan, 20122 Milan, Italy.
Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, 20157 Milan, Italy.
J Clin Med. 2024 Dec 10;13(24):7511. doi: 10.3390/jcm13247511.
: ST-segment elevation myocardial infarction (STEMI) remains a leading cause of mortality worldwide, primarily caused by acute thrombosis over atherosclerotic plaques. Simultaneous acute thrombosis in two coronary arteries is an exceptionally rare event. This report highlights a unique case of STEMI associated with cardiogenic shock due to dual coronary artery thrombosis and provides insights from a literature review on this rare condition. : We report the case of a 58-year-old male with a history of hypertension, type II diabetes, and heavy smoking, who presented with a two-day history of chest pain and cardiogenic shock. Diagnostic evaluation included an electrocardiogram showing ST-segment elevation in AVR and ischemia, along with echocardiography revealing severe left ventricular dysfunction (ejection fraction 20%). Emergency coronary angiography was performed to identify the underlying pathology. Additionally, a literature review was conducted to analyze the characteristics and outcomes of similar cases of dual coronary artery thrombosis. : Coronary angiography identified significant occlusions in the proximal circumflex branch and the left anterior descending artery (LAD), a combination rarely reported in the literature. Our review confirmed that dual thrombosis involving the LAD and right coronary artery (RCA) is the most frequently described presentation of this condition, while simultaneous CFX and LAD thrombosis is exceedingly rare. Most reported cases, including ours, were associated with cardiogenic shock, highlighting the severity of this clinical entity. Despite successful thrombus aspiration and stenting, our patient experienced severe complications, including infections, pleural effusions, and paralytic ileus, ultimately requiring evaluation for left ventricular assist device implantation. : This case underscores the complexity and critical challenges of managing STEMI with cardiogenic shock due to simultaneous coronary thrombosis. The findings from our literature review suggest the need for heightened clinical awareness and tailored revascularization strategies. Further studies are warranted to optimize management approaches and improve outcomes in such rare and high-risk scenarios.
ST段抬高型心肌梗死（STEMI）仍是全球主要的死亡原因，主要由动脉粥样硬化斑块上的急性血栓形成所致。两条冠状动脉同时发生急性血栓形成是极为罕见的事件。本报告重点介绍了一例因双冠状动脉血栓形成导致心源性休克的STEMI独特病例，并通过文献综述对这种罕见病症进行了深入分析。
我们报告一例58岁男性患者，有高血压、II型糖尿病和重度吸烟史，因胸痛和心源性休克就诊，症状持续两天。诊断评估包括心电图显示AVR导联ST段抬高及心肌缺血，超声心动图显示严重左心室功能障碍（射血分数20%）。进行了急诊冠状动脉造影以确定潜在病因。此外，还进行了文献综述，分析双冠状动脉血栓形成类似病例的特征和预后。
冠状动脉造影显示回旋支近端和左前降支（LAD）存在严重闭塞，这种情况在文献中鲜有报道。我们的综述证实，LAD和右冠状动脉（RCA）同时发生血栓形成是该病症最常见的表现形式，而CFX和LAD同时发生血栓形成极为罕见。包括我们的病例在内，大多数报告病例都伴有心源性休克，凸显了这种临床病症的严重性。尽管成功进行了血栓抽吸和支架置入术，但我们的患者仍出现了严重并发症，包括感染、胸腔积液和麻痹性肠梗阻，最终需要评估是否植入左心室辅助装置。
该病例强调了因冠状动脉同时血栓形成导致STEMI合并心源性休克的管理复杂性和严峻挑战。我们文献综述的结果表明，需要提高临床意识并制定针对性的血运重建策略。有必要进一步开展研究，以优化管理方法并改善此类罕见且高危情况下的治疗效果。
