• Hesham R Omar, Devanand Mangar, Enrico M Camporesi, Rachel Karlnoski, and Hany D Abdelmalak.
• Internal Medicine Department, Mercy Hospital and Medical Center, Chicago, IL, USA. hesham_omar2003@yahoo.com
• Am J Emerg Med. 2012 Nov 1;30(9):2093.e5-8.

AbstractST-segment elevation myocardial infarction is usually caused by plaque rupture and subsequent thrombosis of a single culprit vessel. In rare occasions, simultaneous thrombosis of 2 coronary arteries occurs, which is usually associated with a worse prognosis. Although surgery provokes hemodynamic stress, leading in some instances to myocardial ischemia due to supply/demand mismatch, other factors may also contribute to postoperative myocardial infarction. We present a case of postoperative simultaneous left anterior descending and right coronary stent thrombosis that followed cessation of long-term aspirin therapy in a patient with stable coronary artery disease. This case raises concerns with drug-eluting stents due to the higher potential for late stent thrombosis related to delayed endothelialization of the stent struts. Physicians should be very cautious when deciding to withdraw antiplatelet therapy preoperatively to avoid rebound coronary thrombosis.

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