Non-ST elevation myocardial infarction in a patient with severe degenerative aortic stenosis

Abstract

Among heterogeneous groups of patients admitted to the catheterisation laboratory due to non-ST elevation myocardial infarction (NSTEMI), there are increasing numbers with coexisting valvular heart diseases. A 66-year-old man was transferred to our centre with a diagnosis of NSTEMI. Immediate echocardiogram was performed in which a left ventricular ejection fraction (LVEF) of 50% with regional wall motion abnormalities and aortic stenosis was present. Urgent coronary angiography showed near total occlusion (99% stenosis) in the mid-segment of the left circumflex artery. During the same procedure, we performed percutaneous coronary intervention of the infarct-related artery (IRA) with direct bare metal stent implantation. An optimal distal flow in the IRA (TIMI 3) was achieved. An echocardiography assessment performed the next day revealed an improvement of the LVEF (from 50% to 61%) and severe aortic stenosis with maximum transaortic pressure gradient of 123 mm Hg (mean 69.6 mm Hg) and aortic valve area 0.8 cm2. Adhering to the Heart Team's recommendation, surgical aortic valve replacement (AVR) was planned for eight weeks after hospital discharge. We considered the possibility of changing the qualification of urgent AVR, so bare metal stent implantation seems to be the optimal treatment strategy for this patient.