Recurrent ST-Segment Elevation Myocardial Infarction with Coexisting Coronary Slow Flow Phenomenon and Right Coronary Artery Occlusion: A Case Report

Abstrak

Background: The Coronary Slow Flow Phenomenon (CSFP) defined as a distinct clinical condition marked by delayed opacification of the distal vasculature during coronary angiography, occurring even in the absence of obstructive lesions or significant stenosis in the epicardial coronary arteries. Its acute coronary syndrome-like presentation can complicate causal interpretation when obstructive coronary disease is also present. Case Presentation: A 49-year-old male with two previous ST-segment elevation myocardial infarctions presented with acute chest pain, ST-segment elevation in leads V1-V4, and troponin concenctration of 0.966 ng/dL. Coronary angiography demonstrated a dominant RCA with total proximal occlusion. The LM artery was patent; the LAD and LCx arteries had no significant focal stenosis but were markedly tortuous and showed delayed contrast transit. A proximal LAD artery aneurysm was also observed. Discussion: The findings support coexistence of obstructive coronary disease and an angiographic slow-flow pattern. Because corrected TIMI frame counts and adjunctive coronary imaging were unavailable, he ST-segment elevation cannot be attributed to coronary slow flow alone. Conclusion: When slow flow and an occlusive lesion coexist, complete angiographic assessment and cautious causal attribution are essential. Recognition of slow flow should complement, not delay or replace, guideline-directed evaluation and treatment of acute coronary occlusion.