Aortic Dissection Manifesting as ST-Segment–Elevation Myocardial Infarction

An 80-year-old man presented to the emergency department with acute chest discomfort. An ECG showed sinus rhythm with 1-mm ST-segment elevation in the inferior limb leads. He was brought to the cardiac catheterization laboratory for primary percutaneous coronary intervention. Selective angiography of the left coronary system showed no obstructive disease. The initial attempt to selectively engage the right coronary artery (RCA) was unsuccessful, and contrast injection through the JR-4 catheter showed aortic regurgitation (Figure 1 and Movie I in the online-only Data Supplement). After …