Case Report: Smoking as the risk factor of persistent STEMI after primary percutaneous coronary intervention: how it could be happen?

Abstract

Background Acute coronary syndrome (ACS) is a common disease. Smoking may increase the risk of ACS. The most advantageous therapy is percutaneous coronary intervention. This therapy may fail which is no-reflow phenomenon as the result. Total occlusion may increase the risk of no-reflow phenomenon which it could be worse with smoking as the habits. ST-elevation myocardial infarction (STEMI) may show in electrocardiogram (ECG). Case description A 37-year-old male came to the hospital with chest pain as the main complaint. ECG examination showed that there was wide anterior STEMI. Coronary angiography was then done and confirmed that there was total occlusion in left anterior descending artery. After two days hospitalization, the patient developed to cardiogenic shock and lead to acute decompensated heart failure. An ECG showed there was STEMI anterior after primary PCI. Discussion Many chemicals agent contain in cigarette smoking and it may induce the lipid oxidation which leads to plaque deposits. Plaque that deposits in coronary artery may rupture and make thrombus occlusion. This occlusion may partial or total, when there is total occlusion, STEMI was the result. Then, releasing the occlusion is needed for this situation ant PCI may be chosen as the therapy. Patient with wide ischemia may result the no-reflow phenomenon which may lead to heart failure and shock cardiogenic as the complication. Conclusion Smoking may induce ACS which leads to STEMI and may increase the failure of PCI therapy. No-reflow phenomenon is the evidence of miscarriage in therapy which it may increase because of smoking.