CONGRESS ABSTRACT

Background: Acute ST-segment elevation myocardial infarction (STEMI) is a leading cause of mortality, frequently caused by a single coronary thrombosis. Simultaneous acute thrombosis in two coronary arteries is exceedingly rare and poses significant diagnostic and therapeutic challenges. This case highlights the clinical management of dual coronary thrombosis in the context of STEMI complicated by cardiogenic shock and reviews similar cases in the literature.   Case Presentation: A 58-year-old male with a history of hypertension, type II diabetes, and heavy smoking presented with a two-day history of chest pain and cardiogenic shock. Electrocardiogram revealed ST-elevation in AVR, and echocardiography showed severe left ventricular dysfunction (EF 20%). Coronary angiography identified simultaneous occlusions in the proximal left anterior descending (LAD) and circumflex (LCx) arteries, an extremely rare presentation. The patient was treated with noradrenaline and dobutamine for hemodynamic support, in combination con intra-aortic balloon pump (IABP) therapy. Emergency revascularization was performed with thrombus aspiration and stenting. Despite intervention, the patient developed complications including infections, pleural effusions, and refractory heart failure, necessitating evaluation for left ventricular assist device (LVAD) implantation.   Discussion: Dual coronary thrombosis represents a critical subset of STEMI cases, often associated with cardiogenic shock and poor outcomes. Mechanisms include plaque instability, embolism, or vasospasm. Literature review indicates the most common dual thrombosis involves the LAD and right coronary artery (RCA), with LAD and LCx thrombosis being rare. Management strategies are challenging due to hemodynamic instability and limited guidelines for dual culprit lesions.   Conclusions: This case underscores the need for heightened clinical awareness and rapid, tailored revascularization strategies in dual coronary thrombosis. Multidisciplinary approaches, including advanced hemodynamic support and consideration of mechanical circulatory devices, are crucial to improving outcomes in this rare but severe condition.   Keywords: STEMI, cardiogenic shock, dual coronary thrombosis, revascularization, noradrenaline, dobutamine, IABP