Nondominant Right Coronary Artery Occlusion Leading to an Anterior ST-Segment Elevation Myocardial Infarction

A nondominant right coronary artery supplies a small portion of the myocardium. Albeit rare, an acute occlusion of a nondominant right coronary artery is believed to be inconsequential with minimal clinical relevance.

We present a case of a middle-aged man who presented with chest pain and an electrocardiogram demonstrating anterior ST-segment elevation. An emergent coronary angiogram revealed acute thrombotic occlusion of the proximal nondominant right coronary artery with no significant obstructive atherosclerotic disease in the dominant left coronary circulation. Balloon angioplasty of the occluded vessel followed by implantation of a drug-eluting stent resulted in the resolution of the chest pain and ST-segment elevation.

While electrocardiographic ST-segment elevations in the anterior precordial leads are highly suggestive of a left anterior descending artery occlusion, herein, we present a rare case of an acute anterior ST-segment elevation myocardial infarction secondary to a nondominant right coronary artery occlusion.