Acute ST-Elevation Myocardial Infarction Caused by Simultaneous Occlusion of Two Culprit Arteries

ST-elevation myocardial infarction (STEMI) is usually caused by acute thrombosis of a single culprit vessel, whereas STEMI caused by the simultaneous thrombosis of multiple coronary arteries is rare. A review of 711 STEMI cases undergoing percutaneous coronary intervention (PCI) revealed that only 2.5% of patients had acute coronary thrombosis of multiple arteries. We present a case of an 80-year-old female with a history of hypertension who presented with acute onset chest pain and underwent emergent angiography. Her angiography showed acute coronary thrombosis of both the distal left anterior descending artery (dLAD) and the distal obtuse marginal branch 3. She underwent PCI and had restoration of flow. Given the unique presentation of simultaneous multiple coronary thrombi, she underwent additional diagnostic workup before being discharged with guideline-directed medical therapy. While the American College of Cardiology and the European Society of Cardiology guidelines address culprit lesion only PCI versus complete revascularization of non-infarct related lesions, there are no guidelines or randomized controlled trials that have attempted to characterize the best management of STEMI caused by multiple culprit lesions. As a result, the best management of these cases is not standardized. Further case reports leading to prospective studies are needed to better predict outcomes and guide future management.