STEMI in post partum: how can OCT be helpful?

Dr Sonia Houssany  et Dr Julien Adjedj
Hôpital Cochin, Paris

A 38 years old woman was admitted to our department by mobile care unit for chest pain at day 7 of post partum.

Her medical history included only gestational diabetes and a smoking habit.

She experienced chest pain at rest, while waking up and called for medical assistance. ECG revealed a ST elevation in anterior lead, therefore the patient was referred to the cath lab for coronary angiography.

ECG

The coronary angiography was done by transradial approach at H3 and revealed a total occlusion in proximal LAD (TIMI0) with an aspect of ostial dissection.

Coronary angiogram:

OCT showed a long dissection from the mid part of the LAD to the ostium.

A WHISPER ES guidewire was introduced into the LAD, until the distal part of the artery and a new OCT run was made to ensure that the guidewire was in the true lumen.

TIMI 2 flow was restored and chest pain stopped.

The patient was monitored in cardiologic intensive care unit and treated with curative anticoagulation therapy. The bedside echocardiography showed a low left ventricular ejection fraction at 30% with akinesia of septum and anterior wall.

The patient was discharged at day 12 under beta blockers, conversion enzyme inhibitors and anticoagulation.

At two months follow up, she was asymptomatic but LVEF recovery was slow (40%).

Key messages:

Spontaneous coronary dissection is a rare but serious cause of STEMI in young patients.

OCT is a simple tool that can be helpful to understand the mechanism of the coronary occlusion and guide the percutaneous coronary intervention.