Coexisting nephrotic syndromes influences in st elevation myocardial infarction patient and chronic limb-threatening ischemia patient: is there any correlation?
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Iwan Dakota1, Taofan Taofan1, Suci Indriani1
1Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia.
Insights
Nephrotic syndrome (NS) increases the risk of arterial thromboembolism (ATE), leading to emergencies like ST-elevation myocardial infarction (STEMI) and chronic limb-threatening ischemia (CLTI). Early screening and individualized treatment are crucial for managing ATE in NS patients.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Thrombosis
Background:
- Nephrotic syndrome (NS) is an underrecognized risk factor for arterial thromboembolism (ATE).
- Severe cardiovascular emergencies like ST-elevation myocardial infarction (STEMI) and chronic limb-threatening ischemia (CLTI) necessitate prompt intervention.
- Understanding the link between NS and ATE is critical for patient management.
Purpose of the Study:
- To illustrate the diverse presentations of arterial thromboembolism (ATE) in young adults with nephrotic syndrome (NS).
- To highlight the importance of considering NS in patients presenting with cardiovascular emergencies.
- To discuss the underlying mechanisms and management strategies for ATE in the context of NS.
Main Methods:
- Case series presentation of three young adults with NS who experienced ATE.
- Clinical review of patient histories, diagnostic findings, and treatment outcomes.
- Analysis of potential etiological factors including hypercoagulability and atherosclerosis.
Main Results:
- Case 1: Anterior STEMI with high thrombus burden, attributed to ATE in the context of NS.
- Case 2: CLTI with extensive thrombotic occlusions from aorta to lower extremities, linked to NS-associated hypercoagulability.
- Case 3: CLTI with mixed thrombotic and atherosclerotic features, treated successfully with angioplasty.
Conclusions:
- NS predisposes individuals to ATE through hypercoagulability and potentially atherosclerosis.
- Prioritizing cardiovascular screening and preventive measures like thromboprophylaxis in high-risk NS patients is essential.
- Individualized treatment strategies, considering the dominant mechanism (thromboembolic vs. atherosclerotic), are key for optimal outcomes in STEMI and CLTI associated with NS.
Background:
ST-elevation myocardial infarction (STEMI) and chronic limb-threatening ischemia (CLTI) are severe cardiovascular emergencies requiring urgent intervention. Nephrotic syndrome (NS) increases the risk of arterial thromboembolism (ATE), but its exact contribution remains underrecognized.
Case Illustration:
We present three cases of young adults with NS who developed ATE. The first patient had anterior STEMI with high thrombus burden but no significant atherosclerosis, suggesting a thromboembolic event. The second patient, diagnosed with CLTI, had extensive thrombotic occlusions from the infrarenal aorta to the bilateral superficial femoral arteries without atherosclerotic plaques, reinforcing a thromboembolic mechanism. He declined revascularization and was treated with medical therapy, achieving symptom relief. The third patient had CLTI with occlusions in the external iliac and superficial femoral arteries, accompanied by prominent plaque calcification, suggesting an atherosclerotic contribution. He underwent percutaneous transluminal angioplasty with favorable outcomes.
Conclusion:
NS predisposes patients to ATE via hypercoagulability and, in some cases, atherosclerosis. Cardiovascular screening should be prioritized in high-risk patients, and preventive measures, including thromboprophylaxis and lipid management, should be considered. Treatment should be individualized based on the predominant mechanism, with deferred stenting in high thrombus burden STEMI and a multidisciplinary approach for CLTI. Long-term follow-up is essential to prevent recurrence.
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