ST-elevation myocardial infarction (
STEMI) is usually caused by acute
thrombosis of a single culprit vessel, whereas
STEMI caused by the simultaneous
thrombosis of multiple coronary arteries is rare. A review of 711
STEMI cases undergoing
percutaneous coronary intervention (PCI) revealed that only 2.5% of patients had acute
coronary thrombosis of multiple arteries. We present a case of an 80-year-old female with a history of
hypertension who presented with acute onset
chest pain and underwent emergent angiography. Her angiography showed acute
coronary thrombosis of both the distal left anterior descending artery (dLAD) and the distal obtuse marginal branch 3. She underwent PCI and had restoration of flow. Given the unique presentation of simultaneous multiple coronary thrombi, she underwent additional diagnostic workup before being discharged with guideline-directed medical
therapy. While the American College of Cardiology and the European Society of Cardiology guidelines address culprit lesion only PCI versus complete revascularization of non-
infarct related lesions, there are no guidelines or randomized controlled trials that have attempted to characterize the best management of
STEMI caused by multiple culprit lesions. As a result, the best management of these cases is not standardized. Further case reports leading to prospective studies are needed to better predict outcomes and guide future management.