Left main coronary artery occlusion with myocardial infarction in a cocaine user. Successful angioplasty with a drug-eluting stent.

A patient presented with acute ST segment elevation myocardial infarction following cocaine abuse. He was transferred for primary angioplasty. The emergent coronary angiography revealed acute left main coronary artery occlusion. Recanalization with balloon angioplasty was performed, followed by thrombectomy and stenting of the left main coronary artery with a paclitaxel-eluting stent. The patient recovered with a left ventricular ejection fraction of 35% at discharge. The pathophysiology of cocaine-induced myocardial infarction includes vasospasm, thrombosis and increased myocardial oxygen demand. Primary percutaneous coronary intervention allows local delivery of vasodilators and mechanical reperfusion in a timely manner. The authors argue that it is the best option for cocaine-induced ST segment elevation myocardial infarction. Recent data from randomized trials comparing bare metal and drug-eluting stents for primary percutaneous coronary intervention are discussed, as is the lack of evidence supporting the use of thrombectomy devices in acute myocardial infarction. The authors believe that primary percutaneous coronary intervention should be considered early for a patient presenting with cocaine-induced ST segment elevation myocardial infarction.