Simultaneous thromboses of double coronary arteries in a young male with antithrombin III deficiency

In most acute ST-segment elevation myocardial infarction, a single culprit vessel is often found; however, multivessel occlusion, although uncommon, can occur and usually with a poor prognosis, including mortality. We reported a 22-year-old young male who presented to our emergency department because of chest pain after exercise. On physical examination, the cardiac auscultation revealed gallop rhythm without murmur, and the pulmonary auscultation revealed minimal basal moist rales. Other physical examinations were unremarkable. Twelve-lead electrocardiography showed normal sinus rhythm with rate of 96 beats per minute, hyperacute T wave in V1 to V6 and II, III, aVF with reciprocal change in lead I, aVL. He underwent immediate coronary angiography that revealed simultaneous total occlusion of proximal portion of right coronary artery and left anterior descending coronary artery. Successful percutaneous coronary intervention with angioplasty was performed with optimal angiographic result. Although simultaneous total occlusion of double coronary arteries is a rare condition, especially in young group with antithrombin III deficiency, percutaneous coronary intervention and long-term anticoagulant agent are still one of the standard treatments, but the operator should be aware of the hemodynamic change and the importance of mechanical support.