Abstract
Acute ST-elevation myocardial infarction (STEMI) is a life-threatening condition often associated with significant cardiac complications, particularly in the presence of underlying multivessel coronary artery disease. Mechanical complications, such as acute mitral regurgitation (MR), can worsen the clinical course, leading to rapid hemodynamic deterioration. Recent advancements in mechanical circulatory support and percutaneous interventions have introduced new therapeutic options, offering viable alternatives to traditional surgery for high-risk patients. In this case, a 67-year-old male with a history of hypertension presented with sudden-onset chest pain and dyspnea. Electrocardiography revealed an inferior STEMI. En route to the catheterization laboratory, the patient experienced cardiac arrest and was subsequently found to have multivessel coronary artery disease and severe mitral regurgitation. The patient underwent Impella-assisted multivessel percutaneous coronary intervention, complicated by flash pulmonary edema, which necessitated transcatheter mitral valve repair. The patient remained hemodynamically stable and had a successful recovery post-intervention. This case shows the effective use of advanced percutaneous techniques and mechanical support in managing a complex cardiac emergency, highlighting their potential as alternatives to traditional surgery.