Simultaneous anterior and inferior wall myocardial infarction in a patient with unusual coronary anatomy

We report an unusual case, a 56-year-old male whose right coronary artery (RCA) originated as a separate branch from the middle part of the left anterior descending artery (LAD), undergoing acute coronary syndrome. He had multiple coronary risk factors, including diabetes mellitus and cigarette smoking, in addition to age. Electrocardiograms revealed extensive and prominent ST segment elevation over anterior, inferior, and RV leads with spontaneous resolution. Coronary angiography was done thereafter and showed a critical stenotic trifurcation lesion over the middle LAD and RCA orifice. We performed kissing stents for this tough coronary lesion. However, total occlusion of the stents occurred six months later. This case is unique because of the complicated coronary lesions and clinical manifestations.