Coronary thrombus is frequently detected during angiographic imaging in patients presenting with acute coronary syndrome. It usually accompanies a ST-elevation myocardial infarction, but also seen with non-ST elevation myocardial infarction. While it may occur in all coronary arteries, it is uncommon in the main coronary artery. We here present our approach and treatment modality for a patient who presented with a non-ST elevation myocardial infarction with an intense thrombus in the main coronary artery.
Case
A 84 year-old female patient had a history of prior permanent pacemaker, diabetes mellitus and hypertension. She presented to our emergency department following a night-time onset of chest pain. Physical examination showed a blood pressure of 150/90 mmHg, and a pulse rate of 60 beats/min. Rhythm of pacemaker beats was monitored by ECG. After pacemaker was turned off, ECG showed no ST elevation, and cardiac troponin I was 1,2 ng/ml. Patient was transferred to the catheterization laboratory with a diagnosis of non-ST elevation myocardial infarction, during which she received nitrolingual nitrate 5 mg, acetylsalicylic acid 300 mg and unfractionated heparin 5000 U. Coronary angiography demonstrated thrombus in the main coronary artery (figure-1). Due to TIMI 3 flow, and a stable hemodynamic profile the patient was initiated on IV infusion of tirofiban. Then, she was taken to the catheterization laboratory again following 24-hour administration of tirofiban. Coronary angiography revealed that the thrombus in the main coronary artery has resolved (figure-2). With no complaints of chest pain and an additional problem during monitoring, she was discharged from the hospital with recommendations after arrangement of her medical treatment.
In conclusion, we here presented a case report to show that patients presenting with a non-ST elevation myocardial infarction may also have thrombotic lesion in the main coronary artery, and it can be conservatively treated with tirofiban infusion by avoiding emergency intervention if they have a stable hemodynamic profile and TIMI 3 flow.
