Published online Jun 6, 2020. doi: 10.12998/wjcc.v8.i11.2399
Peer-review started: February 19, 2020
First decision: April 29, 2020
Revised: April 29, 2020
Accepted: May 14, 2020
Article in press: May 14, 2020
Published online: June 6, 2020
Increasing attention has been paid to acute myocardial infarction (AMI) in young female patients for whom secondary factors should be considered during the diagnostic process. Anti-phospholipid syndrome (APS), a rare autoimmune disease that is most common in young female patients, is reportedly related to AMI. To date, coronary interventions, particularly stenting, remains controversial in this special clinical scenario.
A 26-year-old female patient was admitted to hospital for acute chest pain, palpitations, and dyspnea. She had a past medical history of APS and pulmonary embolism. Coronary angiography showed acute occlusion of the proximal left anterior descending artery. After repeated thrombus aspirations, residual thrombus and mild stenosis were found in the proximal left anterior descending artery. Optical coherence tomography (OCT) was done, which confirmed the non-atherosclerosis coronary thrombosis and an intact intima in this patient. Deferring or avoiding stenting based on follow-up intracoronary findings with intensified antithrombotic treatment was chosen. One week later, coronary angiography and OCT confirmed an intact intima with no injury and no residual thrombus. The 3-mo telephone follow-up reported a good prognosis.
APS can cause acute non-atherosclerosis coronary thrombosis which presents as an AMI in young female patients. Intracoronary OCT findings can guide interventional strategies in this special clinical scenario.
Core tip: Acute myocardial infarction secondary to antiphospholipid syndrome in young female patients has been reported but not well studied. Coronary intervention, particularly stenting, is still in controversy in this special clinical scenario. Up to now, no specific management, especially intracoronary findings regarding this disease, has been reported. Here we present the direct evidence of acute coronary thrombosis with no atheroma in a young female acute myocardial infarction patient with antiphospholipid syndrome. Also, this case showed good in-hospital recovery with no stenting and intensified antithrombotic treatment using serial optical coherence tomography examinations.