Non-ST-segment Elevation Myocardial Infarction Associated with Multiple Comorbidities in a Patient with a Ventriculoperitoneal Shunt for Obstructive Hydrocephalus Following Traumatic Brain Injury

Abstract

IntroductIonAcute myocardial infarction (MI) remains one of the leading causes of death worldwide. 1 Of all the types of acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the highest mortality rates during hospitalization, followed by non-ST elevation MI (NSTEMI) and unstable angina (UA). However, during the six-month follow-up period, the highest death rate is recorded among NSTEMI patients, followed by STEMI and UA. 2 According to the OPERA registry, one-year mortality rates are also higher for NSTEMI compared to STEMI patients (11.6% vs. 9%). 3The primary cause of the high mortality associated with NSTEMI may be due to the severity of the patients' clinical status. It is well-known that in a relatively high percentage, NSTEMI patients are significantly older, with various associated comorbidities, which in turn lead to an increased risk of cardiovascular events. Approximately one-third of patients presenting with NSTEMI are aged over 75 years, and this age factor has been proven to be one of the most significant risk predictors of NSTEMI, the incidence of complications increasing with age. 4 Patients that present with non-ST elevation acute coronary syndromes frequently present with several comorbidities, ABStrActNon-ST elevation myocardial infarction (NSTEMI) has the highest long-term mortality rates of all acute coronary syndromes. Usually, NSTEMI occurs in elderly patients (>75 years of age) with multiple associated diseases. The complication rate for NSTEMI, including heart failure or hemorrhages, is significantly higher than that in ST-elevation myocardial infarction patients.The case reported is of a 70 year-old male, with a history of ventriculoperitoneal shunt for obstructive hydrocephalus following a traumatic brain injury, who presented with NSTEMI.