Anteroseptal STEMI without the need for primary PCI

Excerpt

A 58-year-old hypertensive man with a history of prior aortic arch endovascular repair was referred to our institution for urgent coronary angiography for typical 2-h chest pain and ECG signs of anteroseptal STEMI (Fig. 1A). The on-call cardiologist was consulted before transferring the patient to the emergency room. Considering the patient's clinical history, antiplatelet agents or heparin were not administered, not excluding acute aortic syndrome among the differential diagnoses. In the emergency room, the patient was alert, in spontaneous breathing, normotensive (blood pressure 120/65 mmHg), mildly bradycardic and still complaining of oppressive non-radiated chest pain. The radial and femoral pulses were regular, easy palpable and symmetrical. An echocardiogram was performed before angiography showing moderate-to-severe aortic regurgitation, dilation of the ascending aorta, and suggestive signs of aortic dissection type A according to the Stanford Classification [1] (Fig. 1B, C, D, E, F). The coronary angiography was then cancelled and a thoracic angio-CT scan was instead performed which confirmed an aortic dissection that originated from the valvular plane up to the implantation of the previous stent with involvement of the common trunk of the left coronary artery (see Fig. 1G). The patient was referred for emergent aortic surgical repair, which was successfully accomplished.

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