An unusual complication of hip surgery: paradoxical coronary embolism of foreign material as a cause of acute MI

A 36-year-old man presented with crushing chest pain 10 days following an elective left hip replacement, which was complicated by a paraprosthetic fracture. Past medical history included psoriasis and left hip arthritis. He was a smoker but denied illicit drug use. The ECG showed inferior ST-segment elevation and anterior ST depression consistent with inferoposterior STEMI, and so he was transferred to our institution for a primary PCI. Emergency angiography revealed filling defects in the left circumflex (LCx) as well as the left anterior descending (LAD) (Figure 1A, Moving image 1, Moving image 2). Coronary thromboembolism was suspected and prolific thrombus aspiration was performed, ...