Karan Abhinav, Feghaly Julien, Blanco Anamarys, Choi Calvin
Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA.
Cardiovascular Diseases, University of Florida College of Medicine - Jacksonville, Jacksonville, USA.
Cureus. 2025 Aug 19;17(8):e90478. doi: 10.7759/cureus.90478. eCollection 2025 Aug.
Dual culprit ST-elevation myocardial infarction (STEMI) refers to the simultaneous involvement of two different coronary arteries, both of which contribute to the ischemic event. It is distinct from multiple plaque ruptures in a single vessel and poses additional challenges, especially regarding timely and effective intervention. Dual culprit STEMI presents several unique diagnostic and management challenges that differentiate it from traditional single-vessel STEMI. The simultaneous involvement of two different coronary artery territories can lead to an atypical presentation and complicate clinical decision-making. Diagnosing dual culprit STEMI requires a high degree of clinical suspicion and thorough imaging. Electrocardiogram (ECG) findings may be more diffuse and nonspecific than in single-vessel STEMI, as ischemic changes may be observed in multiple coronary artery territories. Coronary angiography remains the gold standard for diagnosis. However, the challenge lies in identifying both culprit lesions during the acute phase of the STEMI. The management of dual culprit STEMI poses unique therapeutic challenges, particularly in deciding which vessel to treat first, and how to manage the other lesion(s) within the constraints of the acute setting. Dual culprit STEMI carries a higher risk of adverse outcomes compared to single-vessel STEMI. The presence of two culprit lesions is associated with a larger area of myocardial ischemia, which can lead to higher rates of heart failure, arrhythmias, and mortality. Here, we discuss two cases of dual-culprit STEMI and an approach to diagnosis and management.
双罪犯ST段抬高型心肌梗死（STEMI）是指两条不同冠状动脉同时受累，二者均导致缺血事件。它不同于单支血管内的多个斑块破裂，带来了额外挑战，尤其是在及时有效干预方面。双罪犯STEMI存在一些独特的诊断和管理挑战，使其有别于传统的单支血管STEMI。两条不同冠状动脉区域同时受累可导致不典型表现，使临床决策复杂化。诊断双罪犯STEMI需要高度的临床怀疑和全面的影像学检查。心电图（ECG）表现可能比单支血管STEMI更弥散、更不具特异性，因为可能在多个冠状动脉区域观察到缺血改变。冠状动脉造影仍然是诊断的金标准。然而，挑战在于在STEMI急性期识别出两个罪犯病变。双罪犯STEMI的管理带来了独特的治疗挑战，尤其是在决定首先治疗哪支血管，以及如何在急性期的限制条件下处理其他病变方面。与单支血管STEMI相比，双罪犯STEMI发生不良结局的风险更高。存在两个罪犯病变与更大面积的心肌缺血相关，这可导致更高的心力衰竭、心律失常和死亡率发生率。在此，我们讨论两例双罪犯STEMI病例以及一种诊断和管理方法。
