Case report: ST-elevation myocardial infarction complications. How far will you go?

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Critical Care Medicine

Background:

• ST-elevation myocardial infarction (STEMI) with cardiogenic shock (CS) presents complex management challenges.
• Mechanical circulatory support (MCS) is a critical intervention, often bridging patients to heart transplantation (HTx).
• Prior interventions and complications can impact HTx candidacy in STEMI-CS patients requiring MCS.

Purpose of the Study:

• To review the multidisciplinary management of STEMI-CS.
• To highlight the role of MCS as a bridge to HTx.
• To discuss challenges in HTx candidacy for patients with prior interventions and MCS.

Main Methods:

• Case report of a 63-year-old male with out-of-hospital cardiac arrest due to acute anterior STEMI-CS.
• Emergency percutaneous coronary intervention and HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation.
• Management of postoperative complications including infections and tracheal stenosis.
• Successful heart transplantation (HTx) following LVAD support.

Main Results:

• Successful revascularization and HM3 LVAD implantation.
• Patient weaned from mechanical ventilation post-LVAD implantation.
• Postoperative complications included infections and tracheal stenosis, managed appropriately.
• Successful HTx was performed after addressing complications.

Conclusions:

• A multidisciplinary team approach is crucial for managing STEMI-CS and its complications.
• MCS, specifically LVADs, can be effective bridges to HTx, even in complex cases.
• Careful management of complications is essential for successful HTx candidacy after MCS implantation.