ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION WITH TWO CULPRIT VESSELS AND ITS REVASCULARIZATION STRATEGY

Acute ST-segment elevation myocardial infarction (STEMI) is still the leading cause of morbidity and mortality worldwide. It usually occurs due to thrombotic occlusion of single coronary artery. Rarely, it can also occur due thrombotic occlusion of more than one coronary artery which is deem to be associated with lethal complications. Here we present similar case of  a 60 years old male admitted in the hospital with presenting complain of typical chest pain for 10 hours. There was no past medical history of any disease. On investigation, ECG showed ST-segment elevation in multiple leads (V1-V6, II, III, Avf). Coronary angiogram showed occlusive thrombus in right coronary artery (RCA) and left Anterior Descending artery (LAD). Both Arteries were re-canalized and stents were placed in both arteries. There was slow flow in both arteries post-stenting so despite of stent under expansion it was planned to do Staged Post dilatation. Patient was administered GPIIb/IIIa inhibitor for 48 hours and low molecular weight heparin for 4 days followed by post-dilatation with non-compliant balloon. After giving antiplatelet and anticoagulation therapy, post-dilatation of both stents was done as staged procedure. Keywords: ST-Elevation Myocardial Infarction, Primary PCI, Double Coronary Artery Thrombosis