A 45-year-old man with second
ST elevated myocardial infarction and
cardiogenic shock was admitted to a hospital that had no cardiac catheterization laboratory. The patient underwent
fibrinolytic therapy with
alteplase but died 1 h later. His medical history revealed posterior
myocardial infarction 7 years before, which had been successfully treated with a bare
metal stent of the right coronary artery. The post-discharge observation had been unremarkable with no evidence of ischaemia or
infection but gross non-compliance. Autopsy revealed complete closure of the left main coronary artery and a surprise additional finding, namely SA; the stented portion of the artery was enveloped by an
abscess, and purulent material completely occluded the
stent, which was floating in
pus. Impressions: Since coronary angioplasty is so common, the incidence of late silent SA is probably higher than expected, especially considering that there is often a lack of clinical manifestations. Clinicians should be cognizant of this complication. More attention may be required to assess the condition of existing
stents during repeated interventions. Gross non-compliance and/or early withdrawal from
dual anti-platelet therapy may be directly responsible for the development of silent delayed SA.