Acute Coronary Artery Thrombosis in a Patient With Non-Small Cell Lung Cancer

Patients with cancer are at major risk for both venous and arterial thrombotic complications. Venous involvement of cancer-associated thrombosis encompasses deep vein thrombosis and pulmonary embolism. Arterial manifestations include mainly stroke and myocardial infarction. We present the case of a 59-year-old woman admitted to the hospital for chest pain of five hours duration. She had been diagnosed with advanced lung cancer one month before. Electrocardiogram showed ST-segment elevation in all leads except aVR, suggesting a myocardial infarction. Coronary angiography revealed thrombi in both the right coronary artery and the left anterior descending coronary artery in the absence of any atherosclerotic lesions. Tirofiban infusion was administered; furthermore, a computed tomographic pulmonary angiography showed a distal pulmonary embolism. The patient progressed well and was discharged on anticoagulation with vitamin K antagonist. These findings highly imply that the malignancy altered the patient's blood coagulability and induced the formation of the thrombi ensuing acute myocardial infarction and pulmonary embolism. We will emphasize the relationship between cancer and thrombosis with a special focus on the conservative management strategy with anticoagulant and antiplatelet therapy in acute coronary syndrome without evidence of atherosclerotic lesions.