Evolution of Inflammation-Associated Coronary Artery Disease on Immunosuppressive Therapy

Inflammation plays important roles in the pathogenesis of coronary artery disease (CAD).

This case involves a middle-aged woman with few risk factors for atherosclerotic CAD but elevated erythrocyte sedimentation rate and high-sensitivity C-reactive protein. The patient developed progressive coronary de novo stenosis and restenosis despite optimal revascularization and strict secondary prevention. Immunosuppressive therapy was administered without further revascularization, which was associated with no further progression but even regression of the coronary lesions.

We propose to use inflammation-associated CAD (I-CAD) to define the disease entity of this patient. This case highlights the importance of inflammation in the pathogenesis of and use of immunosuppressive therapy in the treatment of patients with I-CAD.

I-CAD should be considered in patients presenting with progressive CAD despite optimal standard treatment, who have few risk factors for atherosclerosis but manifestations of inflammation. Immunosuppressive therapy might be crucial to control the progression of I-CAD.