Stanford Type A Aortic Dissection After Primary Percutaneous Coronary Intervention for Suspected ST-Segment Elevation Myocardial Infarction.

BACKGROUND

Acute aortic dissection (AAD) can mimic acute myocardial infarction, and although rare, it may occur after percutaneous coronary intervention.

CASE SUMMARY: A 68-year-old man, a smoker with hypertension, presented with chest pain. Electrocardiogram showed Q waves with mild ST-segment elevation. Myoglobin and D-dimer were mildly elevated. Coronary angiography revealed near-total occlusion of the proximal left anterior descending artery with aneurysmal dilation and severe stenosis of the distal right coronary artery. Emergency percutaneous coronary intervention relieved symptoms, but severe chest-back pain with shock recurred 8 hours later. Computed tomography angiography confirmed Stanford type A dissection with rupture and massive pericardial effusion. Despite surgery and intensive care, the patient died of multiorgan failure.

DISCUSSION: In atypical acute myocardial infarction, a rapid loop combining D-dimer, bedside echocardiography, computed tomography angiography, and AAD risk scoring may reduce missed diagnoses.

TAKE-HOME MESSAGE: In chest pain patients with aortic dilation, AAD risk remains despite coronary angiography findings.