409) A 64 year old post-menopausal woman with history of hypertension and coronary artery disease presents to the Emergency Room with severe left sided chest pain that started 1 hour ago at rest. The pain radiates to her left shoulder and her jaw. Her history is significant for per-cutaneous coronary intervention to the left anterior coronary artery and placement of drug-eluting stent 9 months ago. Her medications include aspirin, Clopidogrel, Metoprolol and Lisinopril. One week ago, she had a dental extraction procedure and had discontinued Aspirin and Clopidogel prior to the procedure. She was scared of bleeding and has not resumed these medications yet. A chest X-ray is normal. An electrocardiogram reveals 5mm ST segment elevations in the anterior leads and reciprocal depressions in the inferior leads. Which of the following is the most appropriate explanation of this patient’s presentation?
B) Re-Stenosis within the stent
C) Stent Thrombosis
D) Rupture of a new plaque in anterior coronary artery
E) Stenosis from progressive atherosclerosis of anterior coronary artery