Abstract
A 45-year-old man with history of hypertension and diabetes was admitted in a primary care facility complaining of progressive chest pain, retrosternal, tightening, radiating to left arm and diaphoresis that started at rest, 24 hours ago. A 12-lead electrocardiogram (ECG) showed ST-segment elevation of 2 mm in anterior leads (Figure 1), but unfortunately, no reperfusion strategy was made. After transfer to our service, he developed pulmonary congestion and he was sent to coronary angiography. This showed thrombus in left main coronary artery and total occlusion of left circumflex artery (Figure 2 and Video 1). Because of thrombus migration risk with high potential for cardiac arrest, aggressive medical therapy with triple antiplatelet therapy and anticoagulation was chosen. Dual antiplatelet therapy, with abciximab and enoxaparin 1 mg/kg every 12 hours, was initiated. After seven days, a new coronary angiography showed almost complete resolution of the thrombus. (Figure 3, Video 2). The patient was discharged asymptomatic after dose adjustment of warfarin. ST elevation myocardium infarction continues to be a significant public Received Date: January 27, 2016, Accepted Date: March 07, 2016, Published Date: March 15, 2016.
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