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ST-Elevation Myocardial Infarction Due to Coronary Vasospasm Associated with Eosinophilic Granulomatosis with

Christopher Allen1, Christopher Poyorena1, Lauren B Querin1,2

  • 1Mayo Clinic Alix School of Medicine, Scottsdale, Arizona.

Clinical Practice and Cases in Emergency Medicine
|August 19, 2024
PubMed

Insights

Eosinophilic granulomatosis with polyangiitis (EGPA) can cause ST-elevation myocardial infarction (STEMI) due to coronary artery vasospasm (CAV). Prompt diagnosis and treatment of CAV in EGPA patients are crucial for managing STEMI.

Area of Science:

  • Cardiology
  • Rheumatology
  • Immunology

Background:

  • ST-elevation myocardial infarction (STEMI) can arise from coronary artery vasospasm (CAV), a rare complication of eosinophilic granulomatosis with polyangiitis (EGPA).
  • EGPA is a systemic vasculitis that can affect multiple organs, including the coronary arteries.

Purpose of the Study:

  • To report a case of STEMI caused by coronary artery vasospasm in a patient with known EGPA.
  • To discuss the diagnostic and therapeutic challenges of STEMI secondary to CAV in the context of EGPA.

Main Methods:

  • Case presentation of a 54-year-old male with EGPA and coronary artery disease presenting with inferior STEMI.
  • Coronary angiography revealed a vasospastic lesion treated with intra-coronary nitroglycerin and calcium channel blockers.
  • Continued immunosuppressive therapy (prednisone, mepolizumab) for EGPA management.

Main Results:

  • Successful treatment of the vasospastic lesion and STEMI.
  • Resolution of symptoms with ongoing medical management for both EGPA and vasospastic angina.
  • Demonstration of a rare but significant association between EGPA and coronary artery vasospasm.

Conclusions:

  • Coronary artery vasospasm is a critical consideration in EGPA patients presenting with STEMI.
  • Multidisciplinary management involving cardiology and rheumatology is essential for optimal patient outcomes.
  • Highlighting the importance of recognizing and treating rare manifestations of EGPA.
Abstract

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