Rescue of acute ST-elevation myocardial infarction secondary to traumatic coronary artery rupture: a case report

Trauma-related acute myocardial infarction represents a complex and high-risk condition in the emergency department, necessitating a range of sophisticated treatment strategies. Failure to provide timely and accurate intervention significantly increases the risk of short-term mortality.

We present the case of a 36-year-old male who was admitted to local hospital following a penetrating chest trauma. Relevant diagnostic evaluations revealed haemopneumothorax and shock. Following initial stabilization measures, the patient was urgently transferred to our institution due to haemopericardium, which was initially suspected to be secondary to traumatic aortic dissection. However, the admission electrocardiogram clearly demonstrated concurrent anterior and high lateral wall myocardial infarction. Coronary angiography revealed occlusion of the left anterior descending (LAD) artery. We attempted interventional therapy on the LAD to restore blood flow. However, intraoperative findings revealed complete rupture of the LAD. The patient was transferred to the cardiac surgery department for emergency coronary artery bypass grafting (CABG). The foreign body was successfully retrieved, and the CABG was completed without complications. The patient gradually recovered under short-term ECMO support and was discharged successfully. Follow-up assessments indicate a favourable recovery.

The mechanism underlying traumatic myocardial infarction is complex and variable. Given that emergency physicians and cardiologists often lack extensive experience in such cases, they should exercise caution, conduct a thorough assessment, and meticulously plan each step of diagnosis and treatment.