The role of coronary thrombosis in myocardial infarction: Further evidence shown by intracoronary thrombolysis with streptokinase

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Abstract
Myocardial infarction is usually caused by a thrombus occurring on a significant coronary lesion. A 60‐year‐old male was admitted with an acute evolving anterior myocardial infarction. Three hours after the beginning of chest pain, the electrocardiogram showed ST‐segment elevation in the anterior and lateral leads which persisted despite intravenous nitroglycerin (100 mcg/min). One hour later, an angiogram showed complete obstruction at the origin of the left anterior descending artery (LAD). After intracoronary streptokinase (250,000 units) the LAD opened and a 90% obstruction was seen at its origin. However, an anterior myocardial infarction occurred. One month later, an angiogram showed a slight irregularity at the origin of the LAD. Thus, this case demonstrates that (1) a myocardial infarction may occur with a near normal coronary artery, and (2) a thrombus may occur at the site of a slight coronary irregularity.