Primary stenting in a patient with acute myocardial infarction and primary antiphospholipid syndrome

Area of Science:

• Cardiology
• Rheumatology
• Vascular Medicine

Background:

• Primary antiphospholipid syndrome (APS) is an autoimmune disorder associated with a high risk of thrombotic events.
• Recurrent coronary thrombosis presents a significant clinical challenge, particularly in patients with underlying autoimmune conditions.
• Standard treatment protocols for myocardial infarction may require modification in APS patients due to hypercoagulability.

Observation:

• A patient with primary antiphospholipid syndrome experienced recurrent coronary thrombosis.
• The initial myocardial infarction was treated with streptokinase.
• A subsequent reinfarction involved the right coronary artery.

Findings:

• Primary stenting of the occluded right coronary artery was successfully performed during the reinfarction event.
• This represents the first reported case of primary stent implantation for a right coronary artery occlusion in the context of recurrent thrombosis due to primary APS.
• The patient's recurrent thrombotic events underscore the complexity of managing cardiovascular complications in APS.

Implications:

• Primary stenting may be a viable and effective treatment option for acute coronary syndromes in select patients with primary APS.
• This case expands the therapeutic strategies for managing recurrent coronary thrombosis in autoimmune-related hypercoagulable states.
• Further research is warranted to evaluate the long-term outcomes and safety of primary stenting in APS patients with coronary artery disease.