Poster Discussions/International Journal of Cardiology 147S2 (2011) S103–S130 S109 act in accordance with its mechanism. In this report, a case with stent edge dissection occurring within a short period of time after developing mild chest pain during primary PCI will be presented. This case was 75-year-old male patient with a history of hypertension and coronary artery disease. He underwent a stent implantation, not known its type and size, in the LAD five years ago. The patient was taken in cath lab due to prolonged chest pain and ST segment elevations of 2–3 mm in precordial leads. At that time, he did not suffer from any angina. His coronary angiography showed a 90% of focal stent restenosis in the distal LAD with TIMI 3 flow and a 40% of stenosis next to the proximal of stent as well as mild atherosclerotic plaques in the RCA and Cx artery. The target lesion in the LAD was intervened. The restenosis was predilated with a 3.0 × 20 mm non-compliant baloon. A complete opening with TIMI 3 flow was achieved. After this stage, the patient started suffering from mild but constant chest pain. Multiple angiographic imagings after giving intracoronary nitrate were taken to explain the chest pain. The aorta and RCA was viewed to exclude any reason. Any pathology could not be displayed to explain the chest pain with all these efforts. During this period, the patient’s hemodynamics were stable. Then, we decided to wait for 15 minutes under IV nitrate with close observation. His coronary angiography taken after 15min. showed a focal proximal stent edge dissection which was angiographically visible. A 3.5 × 15 mm drug-eluting stent was implanted. Figure1 shows all images of the patient. His chest pain resolved completely, and the patient was discharged without any problem. In conclusion, even mild chest pain during the procedure may be a precursor of a pathology which will develop in minutes. The chest pain regardless of its severity should always be taken into account, and the patient should not be taken out from the cath lab unless the chest pain is completely explained. Figure 1. PP-021 SPONTANEOUS TWO VESSEL CORONARY ARTERY DISSECTION A. Tokatli, O. Yiginer, B.Y. Cingozbay, F. Kilicaslan, B.S. Cebeci. Department of Cardiology, GATA Haydarpasa Hospital, Istanbul, Turkey Objective: Spontan coronary artery dissection (SCAD) is a very rare clinical condition with an incidence of 0.1% in patients referred for coronary angiography. More than 70% of the patients are women and the mean age is 35–40 years. One third of all SCAD cases occur in the peripartum period, of which one third in late pregnancy and two thirds in the early puerperal period. The peak incidence is in the second week after delivery. Pathogenetic mechanism of peripartum period is still unclear but it is suspected that changing levels of sex hormones may play a role. SCAD is also associated with atherosclerosis. An atherosclerotic plaque rupture may lead to dissection of coronary arteries. SCAD can also be associated with connective tissue disease such as Ehlers-Danlos and Marfan’s syndrome. Degeneration of medial layer of coronary arteries causes to coronary dissection. Some case reports suggest that cocain use, vigirous exercise, SLE and oral contraceptive use may also be associated with SCAD. However, mostly the underlying reason of the dissection cannot be identified. Case: A 53 year old male patient with a history of hypertension was admitted to our department with exertional dyspnea and atypical chest pain. Pathological Q waves were observed at inferior leads. Myocardial perfusion scintigraphy revealed fixed perfusion defect in inferior wall. Coronary angiography demonstrated dissections of the circumflex (Figure) and right coronary artery. Since there were TIMI 3 flow in the distal segments of the affected coronaries, it was decided to follow up the patient closely without performing any intervention. Conclusions: Clinical presentation of SCAD depends on the extent and the severity of the dissection, and ranges from unstable angina pectoris to sudden cardiac death. The diagnosis of dissection is generally made using conventional coronary angiography with multiple views. If it is suspected from the diagnosis, IVUS can be performed. Thrombolytic therapy is discouraged because it may result in further propagation of the dissection due to progression of the intramural haematoma. With conservative measures, coronary artery dissections have even shown complete angiographic resolution after a year. Whether to use aspirin or clopidogrel or both in conservatively treated patients remains debatable. Peripartum period mortality is approximately 40%. Prognosis is beter if underlying cause of the dissection is atherosclerosis. Overall mortality tends to be beter, if the patient survives the acute episode. Therefore it is recommended monitoring patients with SCAD for at least one week in the hospital. PP-022 A CASE OF ISOLATED INFERIOR ST SEGMENT ELEVATION MYOCARDIAL INFARCTION DUE TO OCCLUSION OF THE LEFT ANTERIOR DESCENDING CORONARY ARTERY F. Ozyurtlu 1 , H. Acet 1 , M.Z. Bilik 1 , M.S. Ulgen 2 . 1 Department of Cardiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey; 2 Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakir, Turkey Objective: ST-elevation myocardial infarction (STEMI) is the most common manifestation of acute myocardial infarction on precordial or inferior leads in electocardiography (ECG). The cases without ST-segment elevation in the anterior leads but with ST-segment elevation in immediately taken to the catheterization lab. the inferior leads, the detection of Left Anterior Descending Artery (LAD) stenosis is immediately taken to the catheterization lab. very rare. therefore, we presented a case which have ST segment elevation in only inferior leads in ECG, and angiographically a totally occluded LAD. Results: A 40-year-old female patient suffering from typical chest pain lasting an hour was admitted to the emergency department. She has not any symptom previously. Had a medical history of hypertension, diabetes and hyperlipidemia. physical examination immediately taken to the catheterization lab. of patients was normal. blood pressure was 130/90, HR was 69/minute. In ECG there was 1mm ST segment elevation in inferior leads and there was not significant ST segment changes in the right precordiyal leads. Immediately was taken to the catheterization lab. In angiography we detected totally occluded LAD after D1. There was not any lesion in another porsion of LAD, LCX and RCA. Patient underwent primary PCI. Normal flow was achieved after the procedure and there was not any residual lesion in LAD. After procedure a short- term idiyoventrikular rhythm was observed. After the patient has been included in the intensive care unit, On the follow-up patient’s symptoms resolved completely. On the 4th follow-up day echocardiographycally, segmental wall motion abnormality was not observed and LVEF was 60%. Any serious complication was not occured. After the 1. Follow-up day, the ST segment was returned to isoelectric line. T-wave inversion occurred but patological Q wave was not observed. Fibrinogen was 240mg/dl, CRP: 1.0mg/dl. Total cholesterol, HDL cholesterol, antithrombin-3, protein C, protein-S and sedimentation was normal The patient was discharged from the hospital with oral medication that given at hospitalization. and advised to come to control after a 4-week rest.