{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T06:15:43Z","timestamp":1788156943066,"version":"build-2803163510"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coronary artery anomalies during primary PCI are uncommon but can increase procedural complexity and delay reperfusion in STEMI. Anomalous origin of the right coronary artery (RCA) from the left coronary cusp is a rare congenital variant that poses diagnostic and technical challenges in emergency intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 39-year-old female with insulin-dependent diabetes presented with 10-hour chest pain, diaphoresis, and dyspnea. She was in acute pulmonary edema (Killip III) with sinus tachycardia. ECG showed extensive anterior STEMI, and troponin exceeded 50,000\u2005ng\/L. Echocardiography revealed LVEF 39% with apical hypokinesia. She received standard STEMI therapy and underwent urgent PCI. Radial access failed due to spasm, requiring femoral crossover. Angiography showed proximal LAD occlusion (TIMI 0) and difficulty engaging the RCA. Non-selective aortic cusp injection revealed anomalous RCA origin from the left coronary cusp. Primary PCI to the LAD was performed with a drug-eluting stent, restoring TIMI 3 flow. Door-to-wire time was 52\u2005min and fluoroscopy time 11.5\u2005min. The patient improved clinically, with troponin reduction to 26,000\u2005ng\/L and discharge after 5 days. At 1-month follow-up, LVEF improved to 45%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Anomalous RCA origin from the left coronary cusp is a rare but critical finding in STEMI PCI. Early recognition and adaptive catheter strategy are essential to avoid delay and ensure successful reperfusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1909150","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:40:34Z","timestamp":1788154834000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Unmasking an anomalous coronary artery during emergency STEMI intervention: a rare diagnostic challenge with successful revascularization outcome"],"prefix":"10.3389","volume":"13","author":[{"given":"Muhammad Saad","family":"Reihan","sequence":"first","affiliation":[{"name":"Cardiology Department, Faculty of Medicine, Al-Azhar University","place":["New Damietta, Egypt"]},{"name":"Department of Internal Medicine, General Medicine Practice Program, Batterjee Medical College","place":["Jeddah, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek Ahmed","family":"Ahmed Dabash","sequence":"additional","affiliation":[{"name":"Cardiology Department, Faculty of Medicine, Al-Azhar University","place":["New Damietta, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Mohammed","family":"Ahmed Mostafa","sequence":"additional","affiliation":[{"name":"Cardiology Department, Faculty of Medicine, Al-Azhar University","place":["New Damietta, Egypt"]},{"name":"Hayat National Hospitals","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Ali","family":"Mohammed Hammad","sequence":"additional","affiliation":[{"name":"Cardiology Department, Faculty of Medicine, Kafr Elsheikh University","place":["Kafr Elsheikh, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Husna Irfan","family":"Thalib","sequence":"additional","affiliation":[{"name":"General Medicine Practice Program, Batterjee Medical College","place":["Jeddah, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamdy Abdelazeem","family":"Elkafory","sequence":"additional","affiliation":[{"name":"Cardiology Department, Faculty of Medicine, Al-Azhar University","place":["Cairo, Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Moanes","family":"Mohammed Mohyeldin","sequence":"additional","affiliation":[{"name":"Cardiology Department, Faculty of Medicine, Al-Azhar University","place":["Cairo, Egypt"]},{"name":"Hayat National Hospitals","place":["Jazan, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1002\/ccd.1810210110","article-title":"Coronary artery anomalies in 126,595 patients undergoing coronary 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