Simultaneous two-vessel occlusion causing ST-segment elevation myocardial infarction associated with elevated lipoprotein (a): A case report

Simultaneous occlusion of two coronary arteries during ST-segment elevation myocardial infarction (STEMI) is rare and often associated with hemodynamic instability and poor prognosis. Identification of predisposing factors is crucial for prevention and risk stratification. A 53-year-old man with no classic cardiovascular risk factors other than smoking presented with inferoposterior STEMI complicated by syncope. Emergency coronary angiography revealed simultaneous occlusion of the proximal right coronary artery and distal left circumflex artery. Primary percutaneous coronary intervention was successfully performed in both vessels using intravascular imaging guidance. Subsequent evaluation demonstrated markedly elevated lipoprotein(a) levels (88 mg/dL) in the absence of other thrombotic or inflammatory disorders. Multimodality imaging revealed lipid-rich, macrophage-infiltrated plaques in multiple coronary arteries. Intensive lipid-lowering therapy achieved plaque stabilization during follow-up. This case suggests that elevated lipoprotein(a) may be associated with simultaneous multivessel coronary thrombosis and could contribute to plaque vulnerability and thrombogenicity, highlighting the importance of aggressive lipid management.

Simultaneous multivessel coronary occlusion is a rare but life-threatening presentation of ST-segment elevation myocardial infarction. This case illustrates that markedly elevated lipoprotein(a) may be associated with widespread plaque vulnerability, emphasizing the importance of considering lipoprotein(a) measurement and intensive lipid-lowering therapy even in patients without traditional cardiovascular risk factors.