Inferior ST-Segment Elevation Myocardial Infarction Due to Extrinsic Compression Caused by an Aortic False Aneurysm.

BACKGROUND

A 50-year-old woman with a 2-month history of mechanical Bentall surgery for a type A dissection was admitted to the cardiology department because of an inferior ST-segment elevation myocardial infarction.

CASE SUMMARY: In the presence of atypical chest pain and the discovery of pericardial and pleural effusion, no P2Y12 receptor inhibitor or anticoagulation was administered before the coronary angiography. It revealed diffuse atypical stenosis, and optical coherence tomography showed an oval-shaped artery with no plaque rupture, hematoma, or erosion. Computed tomography scan identified a compressive false aneurysm at the distal Bentall suture, which was surgically repaired by cardiac surgeons. The control angiogram then revealed a subnormal right coronary artery.

DISCUSSION AND TAKE-HOME MESSAGES: This case highlights the recent guidelines from the European Society of Cardiology, which support the utility of intracoronary imaging and qualify the systematic use of P2Y12 inhibitors before the angiogram, even in ST-segment elevation myocardial infarction.