WHEN PERCUTANEOUS CORONARY INTERVENTION (PCI) IS NOT AN OPTION - CONSERVATIVE TREATMENT OF STEMI DUE TO THE CONTRAINDICATIONS AND SEVERE COVID-19 INFECTION

Abstract

Objective: The case report presents patient with the history of ST-segment elevation myocardial infarction (STEMI) and COVID-19 infection. STEMI is one of the acute coronary syndromes, defined as sudden ischaemia of the heart muscle. The most common cause of STEMI is the abrupt cessation in coronary artery blood flow based on pre-existing atherosclerosis. Percutaneous coronary intervention (PCI) remains the gold standard for patients with STEMI. In some cases, due to contraindications, only conservative treatment is possible. Design and method: Case report presentation of the patient admitted to the hospital due to the shortness of breath, cough and chest pain as well as analysis of symptoms, additional tests, diagnosis and treatment options. Results: A 78-year-old woman with the history of heart failure, type 2 diabetes mellitus, obesity, hypertension, chronic kidney disease, several myocardial infarctions, anaemia and thrombocytopenia in the course of myelodysplastic syndrome was admitted to Department of Internal Medicine and Hypertension because of compressive chest pain, deteriorating shortness of breath and cough. In the Emergency Unit COVID-19 infection was confirmed, as well as STEMI was diagnosed. An invasive cardiologist, due to severe thrombocytopenia, qualified the patient for conservative treatment, including fondaparinux, statin, nitroglycerin infusion and beta blocker. Due to the severe course of COVID-19 infection oxygen therapy and pharmacotherapy were implemented. During hospitalization, an attack of atrial fibrillation occurred. Considering the risk of haemorrhage an apixaban was recommended, without antiplatelet agent. The patient was discharged home in general good condition. Conclusions: Reperfusion treatment involves PCI, which should be performed within 120 minutes from the diagnosis of STEMI. Other methods include coronary artery bypass grafting and fibrinolytic treatment. Due to the increased risk of complications, particularly the high bleeding risk, conservative treatment was applied, resulting in a significant improvement of the patient's condition, despite unexpected new incidents.