Acute multi-vessel coronary stent thrombosis.
BACKGROUND
Coronary artery stent thrombosis is a rare but often fatal complication associated with percutaneous coronary intervention (PCI) using both bare-metal stents and drug-eluting stents. Although strict adherence to dual anti-platelet therapy (aspirin plus clopidogrel) minimizes this risk, stent thrombosis will still occur in rare patients, leading to acute, subacute, or late life-threatening acute coronary syndromes.


OBJECTIVE
To present a rare case of acute stent thrombosis involving multiple vessels to increase awareness of this life-threatening condition among emergency physicians, and to review the current guidelines for anti-platelet therapy in this patient population.


METHODS
A 52-year-old man who underwent PCI using drug-eluting stents in two separate coronary vessels presented to the Emergency Department within 2 h of discharge from the hospital with chest pain, dynamic electrocardiogram changes, and elevated cardiac markers. Despite compliance with the current recommendations for post-PCI anti-platelet therapy, urgent repeat catheterization revealed total thrombotic occlusion of both stents, requiring urgent repeat intervention.


CONCLUSIONS
Despite patient compliance with the currently recommended anti-platelet regimen after stent therapy for coronary artery disease, acute stent thrombosis remains a rare but life-threatening risk in both the immediate and delayed post-intervention period. In addition, premature cessation of this anti-platelet therapy stands as the greatest risk factor for such thrombotic events. This case is presented to inform emergency physicians of the current post-PCI anticoagulation recommendations to help mitigate the risk of such complications.
Lawrence
Matthew W
MW
Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California 92134-5000, USA.
Matteucci
Michael J
MJ
Carter
Luthur I
LI
Shepherd
Matthew S
MS
D000208:Acute Disease; D003328:Coronary Thrombosis / Q000209:etiology*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*