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Primary antiphospholipid syndrome with acute myocardial infarction recanalised by PTCA
S Takeuchi1, T Obayashi, J Toyama
1Department of Cardiology, Kariya General Hospital, Japan.
Insights
Young adults experiencing acute myocardial infarction may have primary antiphospholipid syndrome. Percutaneous transluminal coronary angioplasty (PTCA) and anticoagulant therapy proved effective for this condition.
Area of Science:
- Cardiology
- Immunology
Background:
- Acute myocardial infarction (AMI) in young adults is uncommon.
- Antiphospholipid syndrome (APS) is a risk factor for thrombosis.
Observation:
- A 20-year-old male presented with severe chest pain and AMI.
- Coronary angiography showed complete right coronary artery obstruction.
- Diffuse thrombi were present in the left coronary artery.
Findings:
- Successful recanalization of the right coronary artery via percutaneous transluminal coronary angioplasty (PTCA).
- Elevated anticardiolipin IgG antibodies indicated APS.
- PTCA site remained patent at three months post-treatment.
Implications:
- Primary APS should be considered in young adults with AMI.
- PTCA combined with anticoagulant therapy is an effective initial treatment for APS-related AMI.
Abstract:
A 20 year old man with severe chest pain was hospitalised for acute myocardial infarction. Coronary angiography revealed total obstruction of his right coronary artery, which was successfully recanalised by direct percutaneous transluminal coronary angioplasty (PTCA). There was also diffuse thrombi in the left coronary artery that was not recanalised by perfusion with 3000 U pro-urokinase. Anticoagulant therapy was performed after PTCA. Creatine kinase peaked one day after hospitalisation (4805 U/l). The activated partial thromboplastin time was 62.6 seconds (45%). Plasma anticardiolipin IgG antibodies were high (3.8 and 2.7) in repeated examinations. The PTCA site was patent after three months. Primary antiphospholipid syndrome should be considered as a cause of acute myocardial infarction in young adults, and PTCA with anticoagulant treatment is effective for initial treatment of the syndrome.