Background: Coronary artery disease (CAD) is characterized by atherosclerotic plaque that blocks the coronary arteries. It is the leading cause of mortality and contributes to the decline in disability-adjusted life years worldwide. According to recent reports, the incidence of CAD has significantly increased in the Gulf region. In ST-elevation myocardial infarction, a subdivision of acute coronary syndrome, it is essential to perform emergent percutaneous coronary angiography (PCI) to confirm diagnosis and treatment.
Case Presentation: A 54-year-old male ex-smoker with a history of dyslipidemia initially presented with chest pain and loss of consciousness. He was diagnosed with an inferior myocardial infarction (MI), and coronary angiography revealed multi-vessel CAD, involving the left main coronary artery, the left circumflex artery (LCX), and the left anterior descending artery (LAD). The patient underwent a successful PCI. A few days later, he was readmitted due to pre-syncope and dizziness. Following evaluation, the management plan focused on medication compliance and follow up. Five months later, the patient experienced exertional chest pain and shortness of breath. His laboratory results showed elevated B-type natriuretic peptide, and the electrocardiogram showed signs of a prior inferior-posterior MI with sinus bradycardia. An echocardiogram revealed findings consistent with impaired left ventricular function. Moreover, angiography showed significant in-stent restenosis in the LAD and LCX arteries. The patient underwent coronary artery bypass grafting for definitive treatment.
Conclusion: This case underscores the potential risks associated with excessive coronary stenting and emphasizes the need for careful decision-making when selecting the appropriate intervention.
Key words: Key words: coronary artery disease, coronary angioplasty, coronary stenting, coronary artery bypass grafting, in-stent restenosis, case report.
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