P343 WHAT IS HIDING BEHIND A ‘STEMI‘?

Abstract Introduction Stanford type A aortic dissection associated with ST–segment elevation myocardial infarction (STEMI) is a rare event high mortality rate. Emergency coronary angiography and antithrombotic therapy expose to greater risk of complications mortality. Case presentation: 57–year–old heavy smoker gentleman no previous medical history was admitted the emergency department due sudden onset severe oppressive chest pain. The ECG suggestive inferior STEMI thus he brought cath lab. During angiography, there spontaneous regression alterations persistence, however, unremarkable, but cannulation right artery unexpectedly difficult. In light clinic suspicious fluoroscopic images (dilated aorta valvular calcifications), an aortography performed showing dissection. CT confirmed presence confined ascending origin from false lumen. supra–aortic trunks were not involved by bicuspid valve bovine trunk also found. patient therefore underwent cardiac surgery: composite conduit (Bentall procedure) implanted double aorto–coronary bypass surgery performed, intraoperative evidence complete detachment ostium partial left. operation successful following hospitalization uneventful. Conclusions This case report exemplifies important alternative diagnosis in patients referred for STEMI, particularly if localization (the most frequently dissection). It necessary pay attention possible clues coming clinical findings radioscopic angiographic obtained lab order miss pathology on whose recognition timely treatment patient‘s life depends.