PMC4495130_01
A - ECG at admission showing ST elevation in inferior wall leads. B - Angiography showing occlusion in the mid segment of the RCA; LAO 60, CRAN 0. C - Good result of primary PCI, LAO 60, CRAN 0. D - Angiography showing significant lesion in the proximal LAD; RAO 10, CRAN 30
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A 50-year-old male heavy smoker with hypertension and hyperlipidemia, without previous chronic medication, was admitted directly to the catheterization laboratory due to recurrent chest pain lasting for 3 days and ST-segment elevation in II, III and aVF ECG leads accompanied by ST-segment depression in I and aVL ECG leads (Figure 1 A). 300 mg of acetylsalicylic acid, 600 mg of clopidogrel, 5000 IU of unfractionated heparin and sublingual nitrates were administered in the pre-hospital phase. Due to the preliminary diagnosis of acute myocardial infarction, immediate transfemoral coronary angiography was performed, revealing distal occlusion of the right coronary artery, TIMI 0 (RCA, Figure 1 B) and another significant long lesion in the proximal segment of the left anterior descending artery (LAD) with the first diagonal branch involved, with TIMI 3 flow (Figure 1 D, thick arrow). Pre-dilation with a 2.5 mm balloon was performed followed by implantation of two drug-eluting stents, 3.0 x 18 mm proximally and 2.75 x 23 mm distally, with good angiographic effect (Figure 1 C).