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At the day of admission she reported severe thoracic discomfort lasting for 6 hours. The patient’s ECG (Figure 1) at admission showed ischemic ST-depression in the anteroseptal leads with a slight ST-segment elevation in the lead AVR. The patient was on 100mg aspirin once daily, a statin and a beta-blocker (metoprolol succinate). Upon admission, a 600mg clopidogrel loading dose and benzodiazepines were given orally, and morphine hydrochloride and nitrates were administered parenterally resulting in clinical stabilization within 30 minutes. The patient’s physical examination was unremarkable. The patient’s history revealed coronary artery disease with bare-metal stent implantation of the proximal Left Anterior Descending Coronary Artery (LAD) eight years ago and hypercholesterolemia on treatment as relevant cardiovascular risk factors. Furthermore, strumectomy of a retrosternal struma nodosa with sternotomy had been performed twelve years ago.

Interventional Treatment of a Patient with Acute Coronary Syndrome and Multivessel Coronary Artery Disease Who Refuses Cardiac Bypass Surgery