Acute pulmonary embolism mimicking inferior myocardial infarction.

Pulmonary embolism (PE) is a potentially life-threatening emergency that is sometimes difficult to diagnose due to nonspecific symptoms and findings. A 69-year-old male was admitted to our hospital with new-onset chest pain and sweating. The electrocardiogram (ECG) revealed sinus rhythm with ST elevations in the inferior leads. His angiogram showed noncritical coronary artery disease with a few plaques. Right heart catheterization was made, which revealed an elevated pulmonary artery pressure of 45/23 mmHg. A pulmonary angiogram was then performed, at first from the pulmonary trunk and then the right pulmonary artery, which showed occlusion of the pulmonary artery to the right lower lobe. This report emphasizes that acute PE should be suspected in every patient with ST elevation myocardial infarction and normal coronary arteries. ST changes may be in the inferior as well as the anterior leads.

Association of Lymphocyte-to-Monocyte Ratio With the Mortality in Patients With ST-Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention.

We investigated whether the lymphocyte-to-monocyte ratio (LMR) 48 hours after admission is related to 30-day and long-term mortality in patients with ST-elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PCI). We evaluated 318 consecutive patients with STEMI who were undergoing primary PCI. The relationship between the LMR48h and all-cause mortality (30-day and long-term) was analyzed by categorizing the patients into tertiles (T) according to LMR48h-T1 (>2.46), T2 (1.67-2.46), and T3 (<1.67). The T3 group exhibited the highest risk of 30-day all-cause mortality (hazard ratio [HR]: 8.093 [1.006-65.074]; P = .049). For long-term mortality, a significantly higher mortality risk was observed in both T2 (HR: 2.005 [1.021-3.939]; P = .043) and T3 groups (HR: 2.374 [1.160-4.857]; P < .001) compared to the T1 group (reference group). In multivariate analysis, these associations remained unaltered even after adjusting for confounders. A low LMR at 48 hours after admission may be independently associated with both 30-day and long-term mortality in patients with STEMI who were treated with primary PCI. This marker may be used for identifying patients with STEMI at high risk.