{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T23:10:41Z","timestamp":1740179441457,"version":"3.37.3"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,11,24]],"date-time":"2020-11-24T00:00:00Z","timestamp":1606176000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>ST-segment elevation myocardial infarction (STEMI) and peptic ulcer perforation are both medical emergencies that require urgent intervention. In case that these time-sensitive medical emergencies present concomitantly, it remains unclear which one should be treated first.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>An 85-year-old man with melaena, epigastric pain, and severe anaemia was transferred to our emergency department and diagnosed as having inferior STEMI based on electrocardiogram. Emergency coronary angiography (CAG) revealed severe stenosis with thrombus in the proximal right coronary artery. Immediate oesophagogastroduodenoscopy and abdominal computed tomography detected the presence of duodenal ulcer perforation. Primary percutaneous coronary intervention (PCI) without stenting using excimer laser coronary angioplasty and manual thrombectomy was performed under intravascular ultrasound (IVUS) guidance to avoid dual antiplatelet therapy (DAPT). After successful PCI, the perforated viscus was surgically repaired with a laparoscopic omental patch. On Day 7, endoscopic haemostasis treated the oozing of blood from the duodenal ulcer. On Day 21, follow-up CAG and IVUS showed residual stenosis with organized thrombus in the culprit lesion, in which a drug-coated stent was directly implanted. He was discharged with a favourable clinical course on Day 23.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>We judged that PCI should take precedence over the surgical repair of perforated duodenal ulcer in our case since STEMI was an immediate life-threatening compared to the perforated viscus which had no active exsanguination. Excimer laser coronary angioplasty with manual thrombectomy might be an adequate option to avoid stent deployment and subsequent DAPT in such complex scenarios.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaa389","type":"journal-article","created":{"date-parts":[[2020,11,24]],"date-time":"2020-11-24T04:27:40Z","timestamp":1606192060000},"page":"1-6","source":"Crossref","is-referenced-by-count":0,"title":["Primary percutaneous coronary intervention without stenting using excimer laser and manual thrombectomy in STEMI with duodenal ulcer perforation: a case report"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2657-8164","authenticated-orcid":false,"given":"Hirokazu","family":"Yokoi","sequence":"first","affiliation":[{"name":"Department of Cardiology, Rakuwakai Otowa Hospital, 2 Otowa-chinji-cho, Yamashina-ku, Kyoto 607-8062, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5179-1277","authenticated-orcid":false,"given":"Takashi","family":"Yanagiuchi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rakuwakai Otowa Hospital, 2 Otowa-chinji-cho, Yamashina-ku, Kyoto 607-8062, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunpei","family":"Ushimaru","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rakuwakai Otowa Hospital, 2 Otowa-chinji-cho, Yamashina-ku, Kyoto 607-8062, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9396-3564","authenticated-orcid":false,"given":"Taku","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rakuwakai Otowa Hospital, 2 Otowa-chinji-cho, Yamashina-ku, Kyoto 607-8062, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,11,24]]},"reference":[{"key":"2021010812222810800_ytaa389-B1","doi-asserted-by":"crossref","first-page":"2180","DOI":"10.1016\/j.jacc.2005.12.072","article-title":"Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction","volume":"47","author":"McNamara","year":"2006","journal-title":"J Am Coll Cardiol"},{"key":"2021010812222810800_ytaa389-B2","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur Heart J"},{"key":"2021010812222810800_ytaa389-B3","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/j.1399-6576.2011.02609.x","article-title":"The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. 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