Death caused by simultaneous subacute stent thrombosis of sirolimus-eluting stents in left anterior descending artery and left circumflex artery

Nightmare: Simultaneous Subacute Stent Thrombosis of Different New-Generation Drug-Eluting Stents in Multiple Coronary Arteries

Simultaneous stent thrombosis (ST) of first-generation drug-eluting stents (DES) has been rarely reported and could lead to high morbidity and mortality. However, to date there was no literature discussing simultaneous ST of different new-generation DESs in multiple coronary arteries. Herein, we report a 60-year-old male suffering from acute myocardial infarction complicated with cardiogenic shock. He had percutaneous coronary intervention (PCI) performed approximately 7 days prior to admission at a local teaching hospital, with different DES devices implanted over the left anterior descending and the left circumflex artery. Emergency coronary angiography revealed simultaneous subacute ST over both vessels. After PCI, there was a gradual improvement in both cardiogenic shock and acute pulmonary edema. High dose clopidogrel (150 mg) was used initially, which was later shifted to ticagrelor. Genetic testing of CYP2C19*2 G681A polymorphism revealed heterozygous genotype and platelet function testing showed substantial inhibition after a medication change. This rare case should remind physicians that new-generation DES thrombosis in multiple vessels is still a possible complication of PCI, and checking genetic and/or platelet function testing might be indicated in these high risk patients. The use of a new antiplatelet drug was also strongly suggested to avoid possible clopidogrel resistance.

KEY WORDS

Clopidogrel resistance; Drug-eluting stents; Genetic testing; Platelet function; Stent thrombosis.

Two Consecutive Episodes of Acute Myocardial Infarction Occurring in Different Coronary Arteries of a Single Patient with Sepsis

Although recurrent ST-segment elevation myocardial infarction (STEMI) in the same coronary artery due to acute stent thrombosis has been reported in the literature, there have been no reported cases discussing consecutive STEMI recurring in different coronary arteries in the same patient in one day. Herein, we report an elderly male patient initially suffering from STEMI over the inferior wall who subsequently had another episode of STEMI over the anterior wall within several hours. Despite primary percutaneous coronary intervention being performed over both the right coronary artery and the left anterior descending artery, the patient eventually expired notwithstanding intensive care. This case should caution physicians that consecutive STEMI in different coronary arteries is an extremely rare but still possible medical phenomenon, and could lead to catastrophic clinical outcome.

KEY WORDS

Myocardial infarction; Primary percutaneous coronary intervention; Recurrent ST-elevation.