Multi-vessel Atheromatous Plaque Disruption in a Patient of ST-Segment Elevation Acute Coronary Syndrome: A Case Report

Abstract

ST-segment elevation myocardial infarction (STEMI) is a life-threatening manifestation of acute coronary syndrome (ACS), typically caused by the rupture of an atheromatous plaque leading to thrombus formation and coronary artery occlusion. The case report aims to explore the atheromatous plaque disruption in a patient with ST-segment elevation acute coronary syndrome. This case report presents a rare and severe instance of plaque disruption resulting in multi-vessel involvement, highlighting the importance of rapid diagnosis, advanced imaging, and complete revascularisation. This case exemplifies the complexity of STEMI resulting from simultaneous atheromatous plaque disruption in multiple coronary arteries. Intravascular imaging played a pivotal role in confirming plaque disruption and guiding percutaneous coronary intervention (PCI). Recent clinical trials such as COMPLETE, CvLPRIT, and DANAMI-3—PRIMULTI have provided robust evidence supporting multi-vessel PCI in stable STEMI patients. Future research should focus on identifying biomarkers and imaging features predictive of plaque vulnerability, developing personalised treatment algorithms, and exploring novel pharmacologic agents that stabilise plaques and reduce the risk of rupture.