Abstract
Background: Thrombotic occlusion of the coronary artery, which succeeds the atherosclerotic plaquerupture or erosion, gives rise to a major portion of acute myocardial infarction (AMI) incidences.Nevertheless, coronary embolism is gaining increasing recognition as another important factor contributingto AMI.
 Case presentation: A 72-year-old woman with atrial fibrillation (AF) and diabetes mellitus histories,presented with chest pain radiating to the left arm and shoulder that began 6 hours prior to admission.Electrocardiogram revealed AF plus ST-segment elevation in the anterior leads.Intervention: Patient was first treated with anti-platelet agents (aspirin plus ticagrelor) and atorvastatin.Emergency coronary angiography depicted multi-site coronary embolization of the left circumflex artery(LCX) and the left anterior descending artery (LAD). Blood flow was not restored after intracoronaryinjection of 600 ug tirofiban. 40 mg recombinant human prourokinase was then administered via aspirationthrombectomy catheter.
 Outcome: Two weeks later, coronary angiography showed no residual obstructive lesion in the LCX andLAD with TIMI (thrombolysis in myocardial infarction) 3 flow.
 Conclusion: Primary percutaneous coronary intervention is the most effective measure. In the case offailed blood flow restoration, thrombolytic treatment in both intravenous and intracoronary route should beconsidered.
Highlights
The characteristics of acute myocardial infarction (AMI) include atherosclerotic plaque rupture, fissure, ulceration, dissection or erosion with subsequent thrombus in coronary arteries in most cases, which leads to a disturbed balance between the demand and supply of myocardial oxygen and subsequent myocardial necrosis [1].Received: Aug 25, 2021; Accepted: Sep 9, 2021.Clinically, myocardial ischemia can often be identified based on the medical history of the patient as well as the electrocardiography
Blood flow was not restored after intracoronary injection of 600 ug tirofiban. 40 mg recombinant human prourokinase was administered via aspiration thrombectomy catheter
There appeared no improvement in the blood flow after intracoronary injection of 600 ug tirofiban. In consideration of her past history of untreated atrial fibrillation (AF) together with the angiography finding, AF-related coronary artery embolus was highly suggestive as the underlying pathophysiological evidence of the ST elevation myocardial infarction (STEMI). 40 mg recombinant human prourokinase was administered via aspiration thrombectomy catheter
Summary
CE-associated STEMI in AF patients is a rare situation. Systemic anti-thrombosis therapy as well as patient compliance are required to alleviate both short- and long-term adverse effects. Novel approaches for more effective CE treatments in the future are warranted. Conflict of interest The authors declare that they have no conflicts of interest to disclose
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