[ST segment elevation myocardial infarction in a young patient: special physiopathology and unusual management]
1Department of Cardiology, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR CNRS 6284, Auvergne University, 63000 Clermont-Ferrand, France.
Insights
A young patient with ST elevation myocardial infarction experienced ventricular fibrillation due to coronary artery occlusion. Successful treatment involved manual thrombectomy and glycoprotein inhibitors, avoiding stenting based on OCT imaging.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- ST-segment elevation myocardial infarction (STEMI) in young adults is uncommon.
- Thrombotic sub-occlusion of the left anterior descending artery presents a complex clinical scenario.
- Optimal management strategies for large thrombotic burden in young STEMI patients require careful consideration.
Observation:
- A 24-year-old male presented with anterior STEMI complicated by ventricular fibrillation.
- Initial management included manual thrombectomy and Glycoprotein IIb/IIIa inhibitors, restoring TIMI 3 flow.
- Optical Coherence Tomography (OCT) revealed significant thrombus burden without underlying stenosis or plaque rupture.
Findings:
- Medical management with optimal anti-thrombotic therapy was chosen over immediate stenting.
- Serial OCT imaging demonstrated a significant reduction in thrombus burden.
- Absence of significant organic lesions or plaque rupture was confirmed by OCT at 48 hours and 6 months.
Implications:
- This case highlights the potential for successful non-stenting management in selected young STEMI patients with large thrombus burden.
- Serial OCT imaging is valuable for assessing thrombus resolution and guiding treatment decisions.
- Long-term follow-up confirmed sustained recovery of left ventricular function and asymptomatic status without stenting.
Abstract:
We report the case of a 24-year-old patient admitted for anterior ST segment elevation myocardial complicated by ventricular fibrillation and revealing thrombotic sub occlusion of the left anterior descending coronary artery. Revascularization is achieved by manual thrombectomy and use of Glycoprotein GPIIbIIIa inhibitors and permits to restore TIMI 3 flow. Given the large thrombotic burden, the patient is initially treated medically (optimal anti thrombotic therapy without stenting) and benefits from angiographic control 48 hours later with imaging by Optical Coherence Tomography (OCT). It shows a reduction of thrombus burden and lack of significant underlying organic lesion (no organic stenosis or plaque rupture). In view of these data, it was decided to continue medical treatment alone without stenting. OCT imaging at 6 months shows atheroma without stenosis, thrombus or plaque rupture. This young patient remains asymptomatic and recovered normal left ventricular function with a 2-year follow-up.
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