Case report/focused review: Multivessel acute myocardial infarction: Case report and review of the literature

Simultaneous occlusion of multiple coronary arteries is an uncommon clinical entity with only a few cases having been reported. We describe a middle-age patient with no prior cardiac history who presented with myocardial infarction because of thrombi in both the right coronary and left circumflex arteries. The diagnosis was not suspected on based on clinical presentation or electrocardiogram (ECG) but diagnosed on emergent angiography. The patient was treated with multivessel percutaneous coronary intervention with restoration of normal flow in both arteries. The case presentation is followed by a review of the literature. Cardiovascular disease is the most common cause of death in the developed world, and there are approximately 800000 to 900000 acute myo- cardial infarctions (AMI) annually in the United States. But despite the frequency of coronary artery disease and acute coronary syndromes, multivessel AMI in which 2 or more vessels have simultaneous thrombosis is extremely rare. AMI due to simultaneous occlusion of multiple coronary arteries was initially described based on autopsy studies in the late 1970s and early 1980s,^1-3 but only 42 cases with angiographic findings have been reported in detail in the medical literature^4-38 (Table 1). The etiology is not well understood although hypercoagulable states, suspected coronary emboli, and/or diffuse coronary vasospasm have been implicated in individual patients.