Simultaneous multi-vessel coronary thrombosis in patients with ST-elevation myocardial infarction: a systematic
Ahmed Mahmoud1, Marwan Saad2, Islam Y Elgendy1
1Department of Medicine, University of Florida, Gainesville, FL, USA.
Insights
Acute ST-elevation myocardial infarction (STEMI) with multiple coronary artery thrombosis is rare. Patients often present with cardiogenic shock, and primary percutaneous coronary intervention (PCI) is the main treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Acute ST-elevation myocardial infarction (STEMI) can rarely involve simultaneous multiple coronary artery thrombosis.
- Limited data exists on the clinical presentation and management of this specific condition.
Purpose of the Study:
- To review and synthesize existing literature on simultaneous multi-vessel thrombosis in STEMI patients.
- To describe the clinical presentation, management strategies, and outcomes.
Main Methods:
- Systematic literature search of Medline and Web of Science databases (1990-2014).
- Inclusion of case reports, case series, and observational studies reporting multi-vessel thrombosis during primary percutaneous coronary intervention (PCI).
- Exclusion of cases with identifiable causes for thrombosis.
Main Results:
- 56 patients from 29 articles were analyzed.
- Predominantly male (88%) with a mean age of 59 years.
- Cardiogenic shock was a frequent presentation (41%); simultaneous left anterior descending and right coronary artery thrombosis occurred in 50% of cases.
- Primary PCI was the primary treatment (38% used intra-aortic balloon pump).
- In-hospital mortality was 5%.
Conclusions:
- Simultaneous multi-vessel thrombosis during STEMI is a rare but serious condition.
- High incidence of cardiogenic shock necessitates prompt management.
- Further research is required to optimize treatment and outcomes.
Abstract:
Acute ST-elevation myocardial infarction (STEMI) with simultaneous multiple coronary thrombosis has been described, however; the available information about the clinical presentation and management of this condition is scarce. We searched the Medline and Web of Science databases from 1990 until August 2014 for all case reports, case series, and observational studies that reported simultaneous multi-vessel thrombosis at the time of the primary percutaneous coronary intervention (PCI). We excluded the articles that reported an identifiable cause for coronary thrombosis. A total of 29 articles were retrieved yielding 56 patients. Patients were predominantly males (88%) with a mean age of 59 years. Cardiogenic shock was the predominant presentation (41%). Simultaneous thrombosis of the left anterior descending and right coronary arteries was the commonest angiographic finding (50%). Primary PCI was the main treatment modality and an intra-aortic balloon pump was utilized in 38% of the cases. The in-hospital mortality was 5%. Simultaneous multi-vessel thrombosis at the time of STEMI presents a rare condition. The cases reported in the literature presented with a high incidence of cardiogenic shock. Larger studies are needed to address the proper management and evaluate the outcomes associated with this condition.
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