Case report: ST-elevation myocardial infarction complications. How far will you go?

Abstract

Herein, we review the critical role of a multi-disciplinary team approach in managing the intricate complications of ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Mechanical circulatory support (MCS) implantation represents a potentially life-saving intervention, often serving as a bridge to heart transplantation (HTx). However, complications from prior interventions, in patients receiving MCS due to STEMI-CS, may present additional challenges to successful HTx candidacy. A 63-year-old male suffered out-of-hospital cardiac arrest and was hospitalized due to acute anterior STEMI-CS. Emergency percutaneous coronary intervention was performed in the setting of cardiopulmonary resuscitation. Despite successful revascularization and subsequent optimal medical therapy hemodynamic status remained compromised, the decision was made to implant a HeartMate 3 (HM3) left ventricular assist device (LVAD) as a bridge to HTx. HM3 LVAD was implanted without complications and patient was weaned from mechanical ventilation. The later postoperative period was complicated by infections leading to the LVAD-related complications. Moreover, the patient experienced repeated episodes of stridor, which were attributed to significant tracheal stenosis (due to temporary tracheostomy). Finally, a suitable heart donor was found and a successful HTx was performed.