42 yr old Indian male with no risk factors presents with a 2nd STEMI in a different territory. Acute AWMI 4 yr back; PPCI to LAD done. Post intervention, pt on regular medication. This time presents with Acute IWMI. PPCI to RCA done; angio does not reveal any ISR or denovo lesion elsewhere. hsCRP done after 10 days is negative. Lipids normal, No F/h of premature CAD. Likely cause?
Dear Sunil! Very interesting case. To answer on your question I need additional information. What is angiography RCA during first MI? What kind statin and dose patient receive after first MI? LAD was occluded or % of stenosis? RCA was occluded or % of stenosis? And ECHO after first MI (EDVI, ESVI, EF)? Thanks.
Dear Sunil, check also for thrombopenia - HIT, or other thrombophillic syndromes (anti cardiolipinic etc)
Dear Aristeidis!
Thrombocytopenia is unlikely. Heparins are used 5-7 days. Here is another situation. Double myocardial infarction and double stenting. If stenting is a thrombosis or hemodynamically significant stenosis of the coronary artery. It's about coronary plaques.
BR,
Sergey.
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