case_images: PMC6247695_01
case_images: Major patient findings. Emergency ECG at admission (a) documents anterior ST segment elevation in the precordial leads (V1-5) +- the high lateral leads (I and aVL) and reciprocal ST depression in the inferior leads (mainly III and aVF). Spider view of left coronary artery (LAO caudal view LAO 40 , caudal 30 ) (b) before (I) and after (II) successful emergency angioplasty/drug-eluting- (DE) stenting. Arrow demonstrates subtotal ostial stenosis with the present thrombus.
case_images: CRIC2018-4767105.001.jpg
case_images: PMC6247695_01_CRIC2018-4767105.001.jpg
case_images: fig1
case_images: ECG showed anterior wall myocardial infarction (Figure 1(a)). The patient was immediately transferred to the cardiac catheterization laboratory and received successful emergency angioplasty/drug-eluting- (DE) stenting of the subtotally occluded left anterior descending artery (Figure 1(b)).
case_images: CRP levels and cardiac enzyme progress. CRP levels (a) were normal (normal value 0-5 mg/l) at admission and increased as a result of myocardial necrosis/acute phase reaction as expected. CRP apheresis 1 and 2 (blue columns) 34 h and 58 h after the onset of symptoms (27 h and 51 h after first laboratory results, i.e., zero point in the coordinate system) decreased from 28.77 mg/l to 12.58 mg/l during the first apheresis session and from 24.17 mg/l to 11.55 mg/l during the second session, respectively. CRP apheresis thus efficiently counteracted acute phase CRP elevation. Elevated CK/CK-MB and troponin levels at admission (b) documented acute STEMI. CK levels peaked approximately 14 h after the onset of symptoms and decreased afterwards. Y-axis left: pg/ml for hsTroponin T; Y-axis right: U/l for CK and CK-MB.
case_images: CRIC2018-4767105.002.jpg
case_images: PMC6247695_01_CRIC2018-4767105.002.jpg
case_images: fig2
case_images: Plasma CRP levels declined from 28.77 mg/l to 12.58 mg/l during the first apheresis session and from 24.17 mg/l to 11.55 mg/l during the second session, respectively (Figures 2(a) and 2(b)).  Figure 2 also shows cardiac enzyme progress over 72 h.