STEMI at Term Managed With IVUS-Guided Percutaneous Coronary Intervention and Cesarean Delivery

Acute myocardial infarction complicating pregnancy is rare, with a maternal case-fatality rate of 4.5%. ST-elevation myocardial infarction in a near-term gravida requires revascularization, fetal radiation protection, and multidisciplinary coordination.

A 32-year-old woman at 38 weeks of gestation with no cardiovascular risk factors presented with anterior STEMI from total left anterior descending artery occlusion. Emergent radial-access percutaneous coronary intervention was performed without sedation; intravascular ultrasound confirmed wire position through a thrombus-laden occlusion. Overlapping drug-eluting stents restored TIMI flow grade-3, with air kerma below fetal thresholds. Uninterrupted dual antiplatelet therapy continued through cesarean delivery, with blood loss controlled by hemostatic agents. Mother and neonate were discharged in good health.

This case highlights the ambiguity between thrombotic occlusion and spontaneous dissection in pregnancy, the role of intravascular ultrasound when angiography is unreliable, and antiplatelet decision-making when surgery follows percutaneous coronary intervention.

Emergent intravascular ultrasound-guided percutaneous coronary intervention is feasible at 38 weeks of gestation. Multidisciplinary planning, radiation mitigation, and individualized antiplatelet strategy determine outcomes.