{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:07Z","timestamp":1753876207246,"version":"3.41.2"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T00:00:00Z","timestamp":1722816000000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>ST elevation myocardial infarctions are usually a consequence of the occlusion of a single coronary artery, but in 2.5% of the cases, two or more culprit lesions are found. Simultaneous coronary artery occlusion is a potentially life-threatening condition that leads to cardiogenic shock or ventricular arrhythmias.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We presented the case of a 74-year-old man presenting with chest pain and ST segment elevation (STE) in inferior leads and evidence of alternating STE in anterior leads in a pattern like Wellens syndrome type A in subsequent electrocardiogram (ECGs). Emergency coronary angiography (CA) revealed thrombotic occlusion of the proximal right coronary artery (RCA) and sub-occlusion of mid left anterior descending artery (LAD). During the CA, he became haemodynamically unstable requiring intravenous inotropes and vasopressors, and he underwent primary percutaneous coronary intervention of both RCA and LAD culprit lesions. His subsequent hospital stay was uneventful, and he was discharged 5 days later.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>ST elevation myocardial infarction with more than one culprit coronary artery is a rare but at high risk of haemodynamic decompensation. The causes of occlusion of multiple coronary arteries may be several: coronary embolism, coronary ectasia, simultaneous plaque disruption, coronary vasospasm, hypercoagulability states, smoking, and illicit drug abuse. The presumed mechanism behind the presented case may be a combination of release of pro-thrombotic cytokines due to the thrombotic occlusion of the first coronary and low output state secondary to myocardial dysfunction leading to impaired flow in a severe stenotic coronary artery with subsequent thrombosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae394","type":"journal-article","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T07:11:25Z","timestamp":1722841885000},"source":"Crossref","is-referenced-by-count":1,"title":["Double coronary artery occlusion presenting as inferior ST segment elevation myocardial infarction and Wellens syndrome type A: a case report"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3909-5380","authenticated-orcid":false,"given":"Enrico","family":"Marchi","sequence":"first","affiliation":[{"name":"Interventional Cardiology Unit, Careggi University Hospital , Largo G.A. Brambilla 3, 50141 Florence , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5861-5882","authenticated-orcid":false,"given":"Iacopo","family":"Muraca","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, Careggi University Hospital , Largo G.A. Brambilla 3, 50141 Florence , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1302-4402","authenticated-orcid":false,"given":"Daniel","family":"Cesarini","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, Careggi University Hospital , Largo G.A. Brambilla 3, 50141 Florence , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5043-884X","authenticated-orcid":false,"given":"Matteo","family":"Pennesi","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, Careggi University Hospital , Largo G.A. Brambilla 3, 50141 Florence , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0215-9192","authenticated-orcid":false,"given":"Renato","family":"Valenti","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, Careggi University Hospital , Largo G.A. Brambilla 3, 50141 Florence , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,8,5]]},"reference":[{"key":"2024082222561721100_ytae394-B1","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1093\/eurheartj\/ehy462","article-title":"Fourth universal definition of myocardial infarction (2018)","volume":"40","author":"Thygesen","year":"2019","journal-title":"Eur Heart J"},{"key":"2024082222561721100_ytae394-B2","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.amjcard.2009.04.053","article-title":"Multiple culprit arteries in patients with ST segment elevation myocardial infarction referred for primary percutaneous coronary intervention","volume":"104","author":"Pollak","year":"2009","journal-title":"Am J Cardiol"},{"key":"2024082222561721100_ytae394-B3","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.carrev.2015.02.009","article-title":"Simultaneous multi-vessel coronary thrombosis in patients with ST-elevation myocardial infarction: a systematic review","volume":"16","author":"Mahmoud","year":"2015","journal-title":"Cardiovasc Revasc Med"},{"key":"2024082222561721100_ytae394-B4","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1016\/j.jaccas.2021.07.028","article-title":"Double culprit lesions in a patient with ST-segment elevation myocardial infarction","volume":"3","author":"Hage","year":"2021","journal-title":"JACC Case Rep"},{"key":"2024082222561721100_ytae394-B5","first-page":"1","article-title":"Multiple culprit coronary artery thrombosis in a patient with coronary ectasia","volume":"2018","author":"Matte","year":"2018","journal-title":"Case Rep Cardiol"},{"key":"2024082222561721100_ytae394-B6","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1056\/NEJM198307283090406","article-title":"Coronary spasm producing coronary thrombosis and myocardial infarction","volume":"309","author":"Vincent","year":"1983","journal-title":"N Engl J Med"},{"key":"2024082222561721100_ytae394-B7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2023\/8865553","article-title":"Characteristics of Wellens\u2019 syndrome in the current PCI era: a single-center retrospective study","volume":"2023","author":"Zhou","year":"2023","journal-title":"Emerg Med Int"},{"key":"2024082222561721100_ytae394-B8","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.jelectrocard.2004.01.001","article-title":"Electrocardiographic \u201clambda\u201d wave and primary idiopathic cardiac asystole: a new clinical syndrome?","volume":"37","author":"Gussak","year":"2004","journal-title":"J Electrocardiol"},{"key":"2024082222561721100_ytae394-B9","first-page":"e49037","article-title":"The critical role of lambda-shaped QRS-ST-T wave fusion ST-elevation in diagnosing and managing takotsubo cardiomyopathy: a case report and review of literature","volume":"15","author":"Molina-Lopez","year":"2023","journal-title":"Cureus"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytae394\/58734034\/ytae394.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/8\/8\/ytae394\/58888025\/ytae394.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/8\/8\/ytae394\/58888025\/ytae394.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T23:48:30Z","timestamp":1724370510000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytae394\/7727283"}},"subtitle":[],"editor":[{"given":"Julio","family":"Echarte","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Albert","family":"Galyavich","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Andi","family":"Rroku","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Dragana","family":"Dabovic","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Piera","family":"Ricci","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,8]]},"references-count":9,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytae394","relation":{},"ISSN":["2514-2119"],"issn-type":[{"type":"electronic","value":"2514-2119"}],"subject":[],"published-other":{"date-parts":[[2024,8]]},"published":{"date-parts":[[2024,8]]},"article-number":"ytae394"}}