Evolução hospitalar e tardia pós-implante de stent coronariano em paciente com angina instável e síndrome mielodisplásica

Abstract

Percutaneoustransluminal coronary angioplasty, thrombocytopenia, myelodysplastic syndrome.One year previously, he had developed spontaneous gum bleeding and petechiae. On that occasion, his platelet count was 20,000/mm³. Myelogram and bone marrow immunohistochemical studies confirmed the diagnosis of myelodysplastic syndrome involving the granulocytic and megakaryocytic series, with normal erythroid series. The patient was then medicated with folic acid, pyridoxine, and cyanocobalamin. His platelet count remained around 40,000/ mm³, and no further bleeding events occurred.Physical examination showed upper limb hypoplasia (phocomelia), blood pressure of 180/110 mmHg, and heart rate of 96 bpm. Cardiopulmonary auscultation was normal. Resting electrocardiogram showed sinus rhythm with nonspecific ventricular repolarization changes in the inferior wall. During precordial pain episodes, ST-segment depression and T-wave inversion (plus-minus) were observed in the same region. Chest radiography revealed cardiothoracic index of 0.5 and normal pleuropulmonary fields. Transthoracic echocardiogram (TTE) showed moderate left ventricular dysfunction due to hypokinesia of inferior, lateral, and posterior walls, with ejection fraction of 0.40. Results of laboratory tests were as follows: platelet count of 40,000/mm³, leukocyte count of 1,850/mm³, and hemoglobin level of 13.2 g/dl. Clotting profile was within normal limits, with INR (international normalized ratio) 1.09 (normal range 0.90 to 1.26), and activated partial thromboplastin time (aPTT) of 28 seconds (normal range 25 to 45 seconds). Serological tests for B and C hepatitis, HIV, HTLV, CMV, and VDRL were all negative.The patient underwent coronary angiography two hours after receiving 10 units of platelets. The right femoral artery (RFA) approach was used, according to Judkin's technique, using 6F introducer and catheters. The introducer was removed from the RFA immediately after the procedure, and local compression was applied during 20 minutes. Neither bleeding nor hematoma occurred after compression. The examination showed 80% stenosis in the right coronary artery (RCA) ostium, the reference diameter of which was 3.05 mm (Fig. 1) and 30% stenosis in the anterior descending artery.Myelodysplastic syndromes are a heterogeneous cluster of bone marrow disorders characterized by morphological abnormalities of the erythroid, granulocytic, and megakaryocytic series and a hypercellular bone marrow 1 . When the megakaryocytic series is affected, the hemorrhagic tendency is a major aggravating factor. The association of coronary disease and thrombocytopenia due to myelodysplastic syndrome presents a challenge to interventional cardiology, because percutaneous coronary interventions require preventing both intracoronary thrombosis with antiplatelet agents and bleeding after the procedure. Case ReportA sixty-one-year-old retired man was admitted to the hospital with a history of pressure-like precordial pain for eight months. First brought on by heavy exertion, one month before ...