Uncommon Etiology of ST-Elevation Myocardial Infarction: Behçet's Disease-Induced Coronary Aneurysm
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J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00352. Epub December 30, 2024.
A 33-year-old man with Behçet's disease (BD) presented with new retrosternal chest pain and was transferred for primary percutaneous coronary intervention (PCI) due to inferior ST-segment elevation myocardial infarction. Coronary angiography showed aneurysmal dilation of the left coronary system and ectasia of the right coronary artery (RCA), which had a high thrombus burden and slow flow.
Thrombus aspiration was performed with an Export Advance catheter (Medtronic), and a long red thrombus was removed. Intracoronary tirofiban was administered from the aspiration catheter, but no stent was placed due to the patient’s age, aneurysmatic arteries, and a potential relationship with BD. In the cardiac intensive care unit, intravenous tirofiban and a heparin drip were used to achieve a target activated clotting time of 250 seconds. Rheumatology consultation confirmed active BD, leading to high-dose pulse steroids and cyclophosphamide treatment.
The patient was closely monitored for 2 weeks and received triple therapy with aspirin, clopidogrel, and apixaban for 1 month. Follow-up angiography at the third month showed regression of his RCA ectasia with distal Thrombus In Myocardial Infarction-3 flow. Echocardiography demonstrated a left ventricular ejection fraction of 60%, and the patient has reported no symptoms since the event.
There is limited evidence on treating coronary involvement in BD.1-2 Although antithrombotic therapy duration is debated, glucocorticoids and immunosuppressants are the cornerstone for the treatment.2 Vasculitis should be considered in young patients with coronary aneurysm. PCI should be reserved in the inactive disease phase because of the risk of stent/vessel mismatch, vessel overstretching, and coronary dissection risk, unless in cases of high-risk features such as hemodynamic instability.2-3
Affiliations and Disclosures
Deniz Mutlu, MD1; Zafer Akman, MD2; Mehmet Semih Belpinar, MD3; Cezar A. Iliescu, MD, FACC, FSCAI4; Konstantinos Marmagkiolis, MD, FACC, FSCAI4,5; Mehmet Cilingiroglu, MD, FACC, FSCAI, FAHA, FESC, FACP4
From the 1Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota; 2Yale University, New Haven, Connecticut; 3Kartal Kosuyolu High Training and Research Hospital, Istanbul, Turkey; 4University of Texas, MD Anderson Cancer Center, Houston, Texas; 5Tampa General Hospital, University of South Florida, Tampa, Florida.
Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.
Consent statement: The authors confirm that patient consent is not applicable to this article. This is a retrospective case report using de-identified data; therefore, the IRB did not require consent from the patient.
Address for correspondence: Mehmet Cilingiroglu, MD, FSCAI, FACC, FESC, FAHA, University of Texas in Houston, MD Anderson Cancer Center, Houston, TX 77030, USA. Email: cilingiroglumehmet@gmail.com
References
1. Vural U, Kizilay M, Aglar AA. Coronary involvement in Behçet's Disease: what are its risks and prognosis? (rare cases and literature review). Braz J Cardiovasc Surg. 2019;34(6):749-758. doi:10.21470/1678-9741-2019-0003
2. Bettiol A, Alibaz-Oner F, Direskeneli H, ry sl. Vascular Behçet syndrome: from pathogenesis to treatment. Nat Rev Rheumatol. 2023;19(2):111-126. doi:10.1038/s41584-022-00880-7
3. Abou Sherif S, Ozden Tok O, Taşköylü Ö, Goktekin O, Kilic ID. Coronary artery aneurysms: a review of the epidemiology, pathophysiology, diagnosis, and treatment. Front Cardiovasc Med. 2017;4:24. doi:10.3389/fcvm.2017.00024
