Recurrent Acute Coronary Syndrome in a High-Risk Elderly Patient:A Case Report

Background: Acute coronary syndrome (ACS) is a critical condition requiring prompt diagnosis and intervention, particularly in high-risk patients with multiple cardiovascular risk factors. This case report highlights the challenges of managing recurrent ACS in an elderly patient with hypertension, obesity, and a history of smoking, despite optimal medical therapy. Case Presentation: A 72-year-old woman presented with recurrent retrosternal chest pain and was found to have a slightly elevated Troponin T level and deep ST-segment depression on electrocardiogram (ECG), consistent with high-risk ACS without ST elevation. Echocardiography revealed preserved left ventricular function with mild lateral hypokinesis. Coronary angiography demonstrated total occlusion of the circumflex (CX) artery, which was successfully treated with percutaneous coronary intervention (PCI) and stent implantation. The patient was discharged on dual antiplatelet therapy and remained asymptomatic at follow-up. Conclusions: This case underscores the importance of early recognition and intervention in high-risk ACS patients, even in the absence of ST elevation. Timely revascularization with stent implantation was crucial in preventing further complications and improving outcomes. The patient’s multiple risk factors, including hypertension, obesity, and smoking history, likely contributed to the development of ACS. This report emphasizes the need for aggressive risk factor modification and adherence to guideline-directed medical therapy in such patients to reduce morbidity and mortality.