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Cobiss

Vojnosanitetski pregled 2023 Volume 80, Issue 10, Pages: 875-879
https://doi.org/10.2298/VSP210428017D
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Acute coronary syndrome in a young patient with ECG presentation of acute inferior myocardial infarction and acute thrombosis of left main stem coronary artery

Đenić Nemanja (Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia)
Milovanović Branko (Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia)
Romanović Radoslav (Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia)
Stojković Siniša ORCID iD icon (University Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia)
Hladiš Anđelko (Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia), anhladis@gmail.com
Spasić Marijan (Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia)
Džudović Boris ORCID iD icon (Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia)
Dulović Dragan (Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia)
Jović Zoran ORCID iD icon (Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia)
Obradović Slobodan ORCID iD icon (Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia)

Introduction. The left main stem (MS) coronary artery (CA) (MSCA) thrombosis is a rare but potentially lethal manifestation of acute coronary syndrome. The standard approach in treating such patients is the primary percutaneous coronary intervention (pPCI) or CA bypass graft surgery. In some cases, depending on the morphological appearance of the thrombus, findings and flow rates assessed on coronary angiography (CAn), clinical conditions, and cardiologist’s experiences, another possible method of treatment can be the conservative approach using antithrombotic therapy. Case report. A 37-year-old male was admitted to the emergency room with symptoms of an acute myocardial infarction with an ST elevation in diaphragmal localization. Using an emergency CAn, we have visualized a thrombus at the ostial and proximal part of the left MSCA, with no complete obstruction of the blood flow. Initially, dual antithrombotic therapy (ticagrelor and acetylsalicylic acid) was applied, and in the further procedure, it was decided to introduce glycoprotein IIb/IIIa platelet receptor inhibitor (tirofiban) as an intracoronary bolus (0.3 μg/kg) and later as a continuous infusion (0.1 μg/kg/min). Four days later, a control CAn and intravascular echocardiography were performed, and it was decided to continue the treatment using conservative therapy without a pPCI procedure. The patient was discharged in good condition with no signs of illness on the eighth day after hospital admission for home recovery, with planned frequent follow-ups in the future. Conclusion. In the case of non-obstructive thrombotic masses without significant atherosclerotic stenotic lesions, conservative treatment modality with the use of aggressive antithrombotic therapy may be considered.

Keywords: coronary artery disease, coronary vessels, myocardial infarction, platelet aggregation inhibitors, treatment outcome

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