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Introduction: ST-segment elevation myocardial infarction (STEMI) frequently manifests as an acute presentation in the Emergency Department. While chest pain is a hallmark symptom along with dyspnea, arm and jaw pain described as dull, heavy, tight or crushing, a considerable number of patients may not exhibit this symptom upon presentation. Epigastric pain is an unusual but potentially critical presenting symptom of STEMI and it poses diagnostic challenges and underscores the importance of considering a broader range of symptoms in the evaluation of acute myocardial infarction(AMI). Case Report: 33-year-old male patient, presented to the Gastroenterology Emergency Department due to epigastric pain. He has a pertinent family history, with his father succumbing to acute myocardial infarction at a young age. Paraclinical investigations revealed elevated levels of lactate dehydrogenase(434.00 U/L) and C-reactive protein(8.38 mg/L), markers for myocardial damage. However, there were no modifications in creatine kinase-MB levels. An electrocardiogram was promptly performed, revealing ST-segment elevation in derivations V1-V5 which primarily reflect myocardial ischemia involving the septal and anterior walls of the left ventricle. During the anamnesis, it was discovered that the patient had a history of regular cocaine use. This information adds a crucial dimension to the case, as cocaine consumption is associated with an increased risk of acute myocardial infarction owing its vasoconstrictive and pro-thrombotic effects. The patient was transferred to another hospital where they underwent angiography, angioplasty, and echocardiography. During the angiography, a lesion in the left dominant coronary artery was discovered together with significant subocclusive stenosis. PCI IVA was successfully performed during the procedure and the patient's condition improved, aided also by the young age. Discussions : Patients presenting with epigastric pain benefit from an electrocardiogram(EKG), as a significant percentage of both men and women with acute myocardial infarction report in clinics similar symptoms. Given the prevalence of epigastric pain in myocardial infarction cases, conducting an EKG evaluation is crucial to assess for possible cardiac etiologies and ensure a comprehensive differential diagnosis. Conclusions: This case underscores the importance of prompt diagnosis of acute myocardial infarction, particularly when presented with atypical symptoms such as epigastric pain. The recognition of cardiac involvement in patients with non-specific complaints like epigastric pain is crucial for timely intervention and improved outcomes. Additionally, the importance of cocaine use as a contributing factor to the risk of myocardial infarction cannot be overstated. Healthcare providers should remain vigilant for cardiac events in individuals with a history of cocaine use. [ABSTRACT FROM AUTHOR]

La pathologie coronarienne constitue la première cause de morbi-mortalité chez les patients nonagénaires, dont le nombre a doublé en vingt ans. En l'absence de recommandations, la place de la stratégie invasive coronaire dans cette population reste un challenge thérapeutique, et son intérêt ainsi que ses risques mal établis. Le but de notre étude était d'évaluer la sécurité de la pratique invasive coronaire dans la population nonagénaire toutes indications confondues. Il s'agissait d'une étude cas-témoin monocentrique menée du 1er janvier 2010 au 30 mai 2019. Les patients inclus étaient l'ensemble des nonagénaires ayant bénéficié d'une coronarographie au centre hospitalier de Troyes au cours de cette période. Pour chaque patient inclus, deux témoins appariés sur le sexe, la date de procédure et l'acte ont été tirés au sort. Le critère de jugement principal était la survenue de complications per- ou post-procédures immédiates durant le séjour au cours duquel était réalisée la procédure. Les principaux critères de jugement secondaire étaient la durée moyenne de séjour, la survenue d'évènements intercurrents durant le séjour (infections nosocomiales, syndrome confusionnel) et la survenue d'une perte d'autonomie. Au total, 59 nonagénaires et 118 témoins ont été inclus dans notre étude. Nous avons recensé 30,5 % de complications majeures chez les nonagénaires versus 10,2 % chez les témoins (p = 0,001 ; OR = 0,26 [0,1–0,6]), avec une différence significative portant sur la survenue d'un choc cardiogénique (p = 0,04), d'une insuffisance cardiaque (p = 0,02) et de troubles rythmiques ventriculaires (p = 0,04). L'insuffisance rénale aiguë post-procédure était plus importante chez les nonagénaires (p = 0,02 ; OR = 0,20 [0,05–1,57]). La durée moyenne de séjour était en moyenne deux fois plus longue chez les nonagénaires. Les patients nonagénaires sont sujets à plus de complications lors de la réalisation d'une procédure invasive coronaire par rapport à des patients de moins 75 ans. Coronary heart disease is the leading cause of morbidity and mortality in nonagenarians, whose numbers have doubled in twenty years. In the absence of recommendations, the place of coronary invasive strategy in this population remains a therapeutic challenge and its interest as well as its risks are poorly established. The aim of our study was to evaluate the safety of coronary invasive practice in the nonagenarian population for all indications. This was a monocentric case-control study conducted from January 1, 2010 to May 30, 2019. The patients included were all nonagenarians who had undergone coronary angiography at the centre hospitalier de Troyes during this period. For each patient included, two controls matched on sex, date of procedure and procedure were drawn at random. The main judgment criterion was the occurrence of immediate per- or post-procedure complications during the stay in which the procedure was performed. The main secondary outcome measures were average length of stay, occurrence of intercurrent events during the stay (nosocomial infections, confusional syndrome), and loss of autonomy. In all, 59 nonagenarians and 118 controls were included in our study. We identified 30.5% major complications in the nonagenarians versus 10.2% in the controls (P = 0.001; OR = 0.26 [0.1–0.6]), with a significant difference in the occurrence of cardiogenic shock (P = 0.04), heart failure (P = 0.02) and ventricular rhythm disorders (P = 0.04). Post-procedure acute renal failure was greater in the nonagenarians (P = 0.02; OR = 0.20 [0.05–1.57]). The mean length of stay was on average twice as long in the nonagenarians. Nonagenarian patients are subject to more complications when undergoing coronary invasive procedures compared to patients under 75. [ABSTRACT FROM AUTHOR]

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