Acute Simultaneous Proximal Occlusion of Two Major Coronary Arteries in Acute Myocardial Infarction: Successful Treatment with Percutaneous Coronary Intervention

Background: Acute myocardial infarction (AMI) due to acute simultaneous proximal occlusion of two major coronary arteries (ASOMC) is a rare but life-threatening situation. Most patients die suddenly or go into cardiogenic shock (CS). In patients with AMI due to ASOMC identified by coronary angiography (CA), percutaneous coronary intervention (PCI) performed in both infarct-related arteries (IRAs) at the same time as diagnostic CA is the fastest option to complete revascularization. However, no prospective studies regarding the outcome of such procedures have been published so far. Methods: In this prospective single-center study, between October 2004 and March 2007, consecutive patients with acute coronary syndrome (ACS) reporting to our university hospital and regional referral center were evaluated for ASOMC by means of emergent CA. When diagnosed with ASOMC, PCI of the IRAs was performed. Clinical data were obtained at baseline, discharge, after 6 months, and after 1 year. Results: Out of 417 patients with ACS, 379 patients (90.9%) suffered an AMI. In 5 patients CA revealed an ASOMC. PCI was performed in 4 patients. One patient with severe triple-vessel disease was referred for emergent coronary artery bypass graft (CABG) surgery after conventional PCI of one IRA. One patient died in-hospital due to early in-stent thrombosis after PCI. At 6-month follow-up and at 1-year follow-up, 4 patients were alive. Conclusion: In spite of the complex interventions, PCI patients had low in-hospital mortality and good clinical results at 1-year follow-up. Our observations are important in the clinical decision-making process of AMI due to ASOMC.