Triple Coronary Artery Thrombosis Presenting as Acute Anterior ST-Segment Elevation Myocardial Infarction

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Acute ST-elevation myocardial infarction (STEMI) typically involves single-vessel coronary artery occlusion.
• Multivessel epicardial coronary artery thrombosis is an infrequent complication of STEMI, often associated with poor prognosis.

Observation:

• A 42-year-old male presented with acute anterior STEMI and thrombosis in three coronary arteries: left anterior descending artery (LAD), circumflex artery (CXA), and right coronary artery (RCA) with its obtuse marginal branch (OM2).
• Initial thrombus aspiration of the LAD was unsuccessful, necessitating percutaneous coronary intervention (PCI) with stenting.
• While RCA thrombosis resolved with tirofiban infusion, CXA and OM thrombosis required additional stenting using the provisional flower petal technique.

Findings:

• Successful PCI of the LAD and subsequent stenting of the CXA and OM achieved Thrombolysis in Myocardial Infarction (TIMI) flow grade III.
• The patient recovered without symptoms and was discharged five days post-intervention.

Implications:

• This case demonstrates the successful management of a complex STEMI presentation with multivessel thrombosis using a combination of PCI and advanced stenting strategies.
• The findings suggest that prompt and tailored interventional approaches can lead to favorable outcomes even in rare, severe cases of coronary thrombosis.