A retrospentive analysis of blood flow perfusion among coronary arteries during double vessel acute simultaneous occlusion in acute ST-elevation myocardial infarction patients

Abstract

Objective To explore the impact on intervascular blood flow perfusion among coronary arteries in order to illuminate the mechanism of acute simultaneous occlusion of double vessels in patients with ST-elevation myocardial infarction (STEMI) . Methods A cohort of 15 consecutive STEMI patients with acute simultaneous occlusion of double vessels admitted from February 2013 to February 2014 were enrolled in this study. Those patients were treated with emergency primary percutaneous coronary intervention (p-PCI) after admission. The clinical data, the procedure of emergency p-PCI and the findings of coronary artery angiography (CAG) were retrospectively analyzed. Results Of 15 patients with STEMI, there were 8 with acute anterior and inferior wall MI, 5 with acute inferior and posterior wall MI and 2 with acute anterior and lateral wall MI. Of them, 14 patients manifested abruptly in the clinical feature of cardiagenic shock, and treatment strategy was one-step revascularization with p-PCI or multiple-step revascularization procedures. All patients were survived after emergency p-PCI and then cared continuously in the Coronary Care Unit. They were checked with CAG, and CAG showed that 6 totally occluded coronary arteries resumed blood perfusion of more than TIMI 2 grade of the blood flow after p-PCI. Conclusions The double vessel occlusion STEMI is rare occurred in clinical medicine. The perfusion of non-culprit artery may be impaired and blocked as soon as the culprit artery was obstructed by thrombus to produce an acute double vessel occlusion of STEMI. And cardiogenic shock might be involved in the pathogenesis process. One-step treatment strategies for STEMI with cardiogenic shock could have clinical practice value. Key words: Acute ST-segment elevation myocardial infarction; Double vessel acute occlusion; Blood flow perfusion