Managing Acute Myocardial Infarction in Shock and Anemia

BACKGROUND: Patients presenting with ST-segment elevation myocardial infarction (STEMI) and concurrent anemia or active bleeding present a therapeutic dilemma. CASE SUMMARY: A 61-year-old woman with a history of pulmonary embolism and a newly discovered lung mass presented with inferior STEMI, critically low hemoglobin level, and hemodynamic instability. Coronary angiography revealed thrombotic occlusion of the posterior left ventricular and posterior descending artery. Revascularization was performed using a drug-eluting balloon (DEB)-only strategy. DISCUSSION: This case illustrates the need for individualized treatment in STEMI patients with cardiogenic shock and high bleeding risk. A DEB-only strategy can be a valuable approach when prolonged antiplatelet therapy is not feasible. TAKE HOME MESSAGES: STEMI in anemic patients poses a major diagnostic challenge. Balancing thrombotic and bleeding risk is a common and challenging aspect of STEMI care. In this setting, the use of DEBs can be a viable alternative to stent implantation for patients with active bleeding.