Project description:We report a patient with angina and no flow-limiting epicardial coronary artery disease who presented with recurrent spontaneous coronary artery dissection resulting in an acute ST-elevation myocardial infarction and evidence of coronary microvascular dysfunction on coronary angiography. We review each condition's pathophysiology and provide a review of the literature for reported associations between these disease processes. <Learning objective: Readers will recognize the considerable overlap of risk factors between patients with spontaneous coronary artery dissection and coronary microvascular dysfunction. Our patient had both conditions underlying her heart disease. We provide a review of the literature regarding the underlying pathophysiology for each condition and underscore possible associations between these disease processes. Further studies are needed to determine a definitive link.>.

| S-EPMC8766347 | biostudies-literature

Unconventional treatment of a giant coronary aneurysm presenting as ST-elevation myocardial infarction: a case report.

Project description:BackgroundThe optimal treatment of aneurysmal or ectatic culprit vessels in the setting of acute myocardial infarction is still matter of debate, as revascularization with either percutaneous intervention or surgery is associated with low procedural success and poor outcomes.Case summaryWe report the case of a 55-year-old male patient, admitted for inferior ST-elevation myocardial infarction, who underwent successful percutaneous implantation of a micro-mesh self-expanding nitinol carotid stent in a right coronary aneurysm with intravascular ultrasonography measured diameter of 9 mm and massive thrombus apposition.DiscussionThe technical characteristics of the micro-mesh self-expanding nitinol carotid stent allow for adequate plaque coverage and good apposition even in large vessels, making this device particularly suitable for the treatment of coronary lesions with high thrombus burden, when severe coronary ectasia or aneurysms are present.

| S-EPMC8564704 | biostudies-literature

A Case of Anomalous Right Coronary Artery Infarction Mimicking ST-Segment Elevation Myocardial Infarction at the Left Anterior Descending Artery.

Project description: Not available

| S-EPMC7515761 | biostudies-literature

Management of Multivessel Coronary Disease in ST-segment Elevation Myocardial Infarction.

Project description:Primary PCI of infarct-related arteries is the preferred reperfusion strategy in patients presenting with ST-segment elevation myocardial infarction (STEMI). Up to 40 % of such patients demonstrate evidence of multivessel, non-infarct-related artery coronary disease. Previous non-randomised observational studies and their associated meta-analyses have suggested that in such cases only the culprit infarct-related artery (IRA) lesion should be treated. However, recent randomised controlled trials have demonstrated improved clinical outcomes with lower major adverse cardiovascular events (MACE) rates when complete revascularisation is undertaken either at index primary percutaneous coronary intervention (PPCI) or during index admission. These trials suggest that current guidelines pertaining to treatment of non-infarct-related artery (N-IRA) lesions in STEMI patients with multivessel disease may need to be reconsidered depending on future trials. However, issues remain around timing of N-IRA intervention, the use of fractional flow reserve (FFR) or intravascular imaging to guide intervention in N-IRA lesions and the need to demonstrate reductions in hard clinical endpoints (death and MI) after complete revascularisation; these issues will need to be addressed through future trials. Clinicians must judge on the currently available data, whether it is still safer to leave important stenosis in N-IRA untreated.

| S-EPMC4523695 | biostudies-literature

Computed tomography coronary angiography in non-ST-segment elevation myocardial infarction.

Project description:Electrocardiography and high-sensitivity cardiac troponin testing are routinely applied as the initial step for clinical evaluation of patients with suspected non-ST-segment elevation myocardial infarction. Once diagnosed, patients with non-ST-segment elevation myocardial infarction are commenced on antithrombotic and secondary preventative therapies before undergoing invasive coronary angiography to determine the strategy of coronary revascularisation. However, this clinical pathway is imperfect and can lead to challenges in the diagnosis, management, and clinical outcomes of these patients. Computed tomography coronary angiography (CTCA) has increasingly been utilised in the setting of patients with suspected non-ST-segment elevation myocardial infarction, where it has an important role in avoiding unnecessary invasive coronary angiography and reducing downstream non-invasive functional testing for myocardial ischaemia. CTCA is an excellent gatekeeper for the cardiac catheterisation laboratory. In addition, CTCA provides complementary information for patients with myocardial infarction in the absence of obstructive coronary artery disease and highlights alternative or incidental diagnoses for those with cardiac troponin elevation. However, the routine application of CTCA has yet to demonstrate an impact on subsequent major adverse cardiovascular events. There are several ongoing studies evaluating CTCA and its associated technologies that will define and potentially expand its application in patients with suspected or diagnosed non-ST-segment elevation myocardial infarction. We here review the current evidence relating to the clinical application of CTCA in patients with non-ST-segment elevation myocardial infarction and highlight the areas where CTCA is likely to have an increasing important role and impact for our patients.

| S-EPMC9733606 | biostudies-literature

Transradial Artery Access in Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock.

Project description:Early revascularization is the gold standard for management of patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS). The use of transradial artery access (TRA) in percutaneous coronary intervention (PCI) has increased in recent years and has emerged as a safe and effective approach to PCI in high-risk patients, with advantages in reduced major bleeding events, other peri-procedural complications, and all-cause mortality when compared with transfemoral artery access (TFA). Multiple randomized clinical trials have demonstrated these advantages of TRA vs. TFA PCI in STEMI patients. Although there remains a lack of dedicated randomized trials in CS, observational data suggest benefits on the same endpoints as in STEMI with TRA vs. TFA PCI in CS. This review summarizes the existing literature on the use of TRA compared to TFA for STEMI and CS patients; the reduction of major bleeding events, other peri-procedural complications, and mortality associated with TRA in STEMI and CS; and technical considerations and challenges in the care of these high-risk patient populations.

| S-EPMC8476228 | biostudies-literature

Multiple coronary artery fistulae presenting with ST-elevation myocardial infarction.

Project description: Not available

| S-EPMC5337078 | biostudies-literature

A huge coronary artery aneurysm with ST-elevation myocardial infarction: A case report and review of literature.

Project description:BackgroundGiant coronary artery aneurysms (GCAA), are rare findings often discovered incidentally in adults. GCAAs are defined by a significant enlargement of coronary arteries, posing a heightened risk of myocardial infarction and thrombosis.Case presentationA 52-year-old male known case of ischemic heart disease (IHD), presented with chest pain and signs of anterior ST-elevation MI (STEMI). He had a history of MI six years ago and was on a medical regimen. Coronary angiography revealed a huge aneurysm (4.8∗8.2mm) in the left anterior descending artery (LAD) and ectasia in other arteries. Surgical management via coronary artery bypass graft (CABG) was pursued, successfully addressing the aneurysm.ConclusionRecent advancements have improved our understanding and imaging capabilities for coronary artery aneurysms (CAAs). Treatment options include medical therapy, percutaneous coronary intervention, or surgery, with decisions tailored to individual cases. Standardized treatment protocols await clarification through further research, including randomized controlled trials.

| S-EPMC11470508 | biostudies-literature

An Uncommon Cause of ST-Segment Elevation Myocardial Infarction: Intramural Coronary Artery Hematoma After Blunt Chest Trauma.

Project description:Intramural coronary hematoma (IMCH) is a rare cause of acute myocardial infarction (MI). We aim to review the current knowledge and share our experience with the diagnosis and management of a patient presenting with traumatic IMCH leading to an acute ST-segment elevation MI. (Level of Difficulty: Intermediate.).

| S-EPMC8304548 | biostudies-literature

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