Plaque rupture after coronary CT angiography.

A 61-year-old man presented to the emergency room with intermittent chest pain. Electrocardiography (ECG) showed no significant ST-T changes. Transthoracic echocardiography revealed regional left ventricular (LV) asynergy in the anterior septum, with an elevated cardiac troponin I level (68.1 pg/mL). Although urgent hospitalization and coronary angiography were recommended for the treatment of a suspected non-ST-segment elevation myocardial infarction, the patient refused as his symptoms had resolved. However, the patient agreed to undergo urgent coronary computed tomography angiography (CCTA). CCTA revealed severe stenosis with high-risk plaque features in the proximal left anterior descending artery (LAD) (Panel A−D).1 After the CCTA, he developed sudden-onset, severe chest pain in the emergency room. An additional ECG showed significant ST-segment elevation in the V2-V5 leads. The patient agreed to undergo urgent coronary angiography. Emergency coronary angiography revealed a lesion in the proximal LAD with complete occlusion (Panel E). Intravascular ultrasonography revealed an intraluminal thrombus secondary to plaque rupture (Panel F). The maximum cardiac enzyme levels were CK (467 IU/L), CK-MB (35 IU/L), and troponin I (8461 pg/mL). The patient had an improvement in LV asynergy at follow-up one-month post-discharge.