ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) WITH CARDIOGENIC SHOCK: HYBRID STRATEGY AND PERIOPERATIVE ISCHEMIC STROKE – CASE REPORT

Abstract

Objective: To describe the implementation of a hybrid therapeutic strategy in a patient with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock and the respective neurological outcome. Method: Retrospective clinical case report based on medical record review, structured according to CARE guidelines and conducted at a tertiary referral center. Results: A 76-year-old woman with inferior STEMI and signs of right ventricular (RV) dysfunction failed to reperfuse after thrombolysis with tenecteplase, progressing to cardiogenic shock. Successful rescue angioplasty of the culprit artery was performed. Due to complex multivessel coronary anatomy (left main and LAD involvement) and high residual risk, surgical myocardial revascularization was chosen after clinical stabilization. In the postoperative period, the patient developed an ischemic stroke, requiring rehabilitation and multidisciplinary support. Conclusions: In cardiogenic shock scenarios, the integration between immediate percutaneous reperfusion and surgical planning (HCR) can be decisive for survival. However, the vulnerability to perioperative neurological events in elderly patients, exacerbated by risk factors such as hypertension and diabetes, represents a significant prognostic challenge requiring intensive vigilance and multidisciplinary management.