Coronary Artery Disease - STEMI Case #1 - Question #1

A 58-year-old male presents to the ED after experiencing intermittent chest pain for 2 days. He describes substernal chest pressure radiating to his jaw. He is short of breath and diaphoretic. His temperature is 100.0, blood pressure is 140/90 mm Hg, respirations are 22 per minute, heart rate is 70 beats per minute and oxygen is 92% on room air. His ECG is below:

AnteriorSTEMI6

He is treated with aspirin, clopidogrel, heparin, metoprolol and oxygen. He is taken for emergency percutaneous coronary intervention. This discovers thrombus in the mid-left anterior descending coronary artery, and primary PCI is performed; however, there was sluggish forward flow afterwards despite the LAD remaining widely patent. Which of the following statements can be made?

A. This is from microvascular obstruction and has no clinical significance.

B. Thrombus aspiration can reduce the incidence of this finding.

C. Glycoprotein IIb/IIIa inhibitors have no definite benefit in this situation.

D. This may have resulted from the patient’s delay in seeking medical attention for his chest pain.

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