A case of ST segment-elevated myocardial infarction with less common forms of single coronary artery
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CASE REPORT
A case of ST segment-elevated myocardial infarction with less common forms of single coronary artery Masashi Koga1 • Yota Kawamura2 • Daiki Ito1 • Harukazu Iseki1 • Yuji Ikari3
Received: 10 July 2015 / Accepted: 14 September 2015 Japanese Association of Cardiovascular Intervention and Therapeutics 2015
Abstract A 60 year-old man presenting with chest pain was diagnosed with acute ST-elevated myocardial infarction. An emergency coronary angiography showed distal left circumflex artery (LCX) occlusion. The ostium of the right coronary artery (RCA) was not detectable. Following primary percutaneous coronary intervention in the occluded LCX, we confirmed that RCA region was fed from both LAD and LCX. Coronary computed tomography showed similar findings. This single coronary artery anomaly is extremely rare and cannot be categorized according to the established classification system. Keywords Single coronary artery ST segment elevated myocardial infarction Primary percutaneous coronary intervention
Introduction Single coronary artery is a rare congenital coronary anomaly occurring in 0.024–0.066 % of the general population [1–4]. Various types and numerous cases of single coronary artery have been reported.
& Yota Kawamura [email protected] 1
Cardiovascular Center, Sagamihara Kyodo Hospital, Sagamihara, Japan
2
Department of Internal Medicine, Division of Cardiology, Tokai University Hachioji Hospital, 1838 Ishikawa-cho, Hachioji, Tokyo 192-0032, Japan
3
Department of Internal Medicine, Division of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
As proposed by Lipton et al. [1], single coronary artery is commonly classified in daily practice according to the location of the coronary ostium. The first coronary origin is designated as right (R) or left (L). The coronary artery supply is then categorized as type I, II, or III. According to Lipton et al. [1], the coronary artery continues to the distal part of the contralateral artery in L-I and R-I, whereas the contralateral coronary artery forms a large transverse trunk at a proximal site in L-II and R-II. In R-III, the right coronary artery extends from the aorta and feeds into the LCX and LAD separately in mid-course. Therefore, the Lipton classification system describes 5 forms of single coronary artery (R-I, R-II, R-III, L-I, and L-II). L-I is thought to account for more than one-third and L-II is about one-fifth of single coronary artery cases [2]. We encountered a case of STEMI with a rare form of single coronary artery that was difficult to classify according to the Lipton’s classification. We found only two reports of this anomaly in the literature [5] [6].
Case report A 60-year-old man with diabetes and hypertension visited our emergency department because of chest pressure for 2 h. His blood pressure was 174/90 mmHg, and his heart rate was 94 bpm with regularity. A physical examination revealed no abnormalities nor did a chest X-ray. An electrocardiogram showed ST segment elevation in the II, III, and aVF
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