Immediate Rupture of Another Coronary Plaque After PCI of the Culprit Lesion in ST Segment Elevation Myocardial Infarction

ST-segment elevation myocardial infarction (STEMI) is usually the result of thrombosis in the single coronary artery. The incidence of multiple coronary artery thrombosis in acute phase is very low. The etiology of multivessel coronary thrombosis is still unclear. Observational studies have shown that plaque instability underlying thrombosis is not due to local vascular causes alone. These pathophysiological processes such as inflammation, sympathic activity and catecholamines discharge act across the entire coronary network and cause multiple plaque instability.1,2 We think that the pathogenesis of multiple coronary occlusive lesions may be explained by multiple atherosclerotic plaque rupture during the acute phase of myocardial infarction. In our case, the first percutaneous coronary intervention was performed on the left anterior descending artery due to anterior STEMI. At the second hour of follow-up, inferior STEMI developed and percutaneous coronary intervention was performed on optus marginalis.