Near simultaneous atherothrombotic occlusion of two coronary arteries challenges the theory of the single vulnerable plaque.

BACKGROUND: It is unlikely that mechanical stress altering a single vulnerable plaque leads to myocardial infarction from almost simultaneous proximal atherothrombotic closure of the right coronary artery and the left anterior descending coronary artery. ACUTE MANAGEMENT: Immediate catheter diagnosis and revascularization including stent deployment restored TIMI III flow in both coronary arteries. After an initial bolus, abciximab was continuously infused to optimize myocardial perfusion. LABORATORY TESTS ON ADMISSION: The patient's white blood cell count was markedly elevated and the level of C-reactive protein slightly so. After interventional recanalization, C-reactive protein rose steeply before falling again after two days. FOLLOW-UP: Thirty days after acute myocardial infarction, the patient was fully recovered and asymptomatic. Echocardiography revealed only mild-to-moderate global left ventricular hypokinesia.
CONCLUSION: Widespread inflammation associated with multifocal plaque rupture and subsequent two-vessel acute myocardial infarction is a rare phenomenon, usually associated with sudden cardiac death. Widespread inflammation is one of the reasons why the widely accepted theory of the single vulnerable plaque for such events can be contradicted.