[Left main coronary artery aneurysm thrombosis in a young patient with acute myocardial infarction]
Irais Cristal Ortiz-Vázquez1, Beatriz Carolina Mendoza-Pérez, Alejandra Madrid-Miller
1Hospital de Cardiología Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, D.F., México. iraiscris24@hotmail.com
Insights
Left main coronary artery aneurysms are rare but can cause acute myocardial infarction. Genetic factors influencing hypofibrinolysis may guide treatment strategies for these complex cases.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Genetics
Background:
- Left main coronary artery aneurysms are rare (0.1% incidence), primarily caused by atherosclerosis.
- Diagnosis and treatment typically rely on angiography.
- Management strategies vary from pharmacological to surgical, depending on coronary stenosis severity.
Observation:
- A 44-year-old male with risk factors (obesity, smoking, dyslipidemia) presented with acute myocardial infarction symptoms.
- Initial treatment with streptokinase failed; rescue angioplasty revealed left main coronary artery aneurysm thrombosis.
- Despite revascularization, the patient experienced cardiogenic shock and did not survive.
Findings:
- The case highlights the challenges of reperfusion in acute myocardial infarction complicated by left main coronary artery aneurysm.
- Genetic analysis was performed to investigate polymorphisms in PAI-1, glycoprotein IIIa, and endothelial nitric oxide synthase genes.
- These genetic factors may be linked to hypofibrinolysis and influence patient outcomes.
Implications:
- Left main coronary artery aneurysms presenting as acute myocardial infarction pose significant management challenges.
- Investigating genetic factors like hypofibrinolysis could improve risk stratification and guide personalized therapeutic decisions (medical, surgical, or interventional).
- Further research into genetic predispositions may optimize treatment approaches for this rare condition.
Introduction:
The left main coronary artery aneurysm is rare, with an incidence of 0.1%, being the atherosclerosis its main etiology. Angiography is the gold standard for diagnosis and treatment. Depending on the severity of coexisting coronary stenosis, patients with left main coronary artery aneurysms can be effectively managed either surgical or pharmacologically.
Clinical Case:
We present a case of a 44 year-old male with a history of obesity, smoking and dyslipidemia, complaining of oppressive chest pain, dyspnea and diaphoresis. An electrocardiogram showed an ST-segment elevation on the anterior and lateral wall and positive enzymatic curve for infarction. He was initially treated with streptokinase with no reperfusion evidence after 3 hours of the onset of symptoms, so he underwent to rescue angioplasty. Angiography reported left main coronary artery aneurysm thrombosis. Afterwards, he presented cardiogenic shock and was revascularized with a coronary artery bypass graft of the mammary artery to the left anterior descending artery and the saphenous vein to the obtuse marginal, however he did not survive. Determination for 4G/5G PAI-1 polymorphism, glycoprotein IIIa PLA1/A2 gene and Glu298Asp polymorphism of the endothelial nitric oxide synthase gene was performed.
Conclusions:
Left main coronary artery aneurysms are rare, finding ONE in an acute myocardial infarction is a serious situation because of the challenging reperfusion techniques that are implied, such as in this case. The search for genetic factors related with hypofibrinolysis could guide stratification and therapy towards medical surgical or interventional management.
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