A spontaneous coronary arterial dissection associated with a calcineurin inhibitor: Figure 1

Abstract

SummaryWe present the case of a 55-year-old lady presenting 5 months after a liver transplant with acute coronary syndrome. She was on maintenance-dose tacrolimus. An angiogram diagnosed a spontaneous coronary artery dissection, which was successfully stented. This is the third case in the literature associating a calcineurin inhibitor with a spontaneous coronary arterial dissection. The detrimental effect of calcineurin inhibitors on vasculature is well recognised. This report highlights their potentially serious side-effects. It should be appreciated that calcineurin inhibitors have the potential to cause or contribute to this rare vascular phenomenon and the diagnosis should therefore be considered in those taking such drugs. BACKGROUND

European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection

“…A number of mechanical triggers have been linked to SCAD events, including extreme Valsalva-type manoeuvres and the provocation of coronary spasm (Supplementary material online, Table S2). 4,9,[79][80][81][82][83][84][85][86][87][88][89][90][91][127][128][129][130][131][132][133] Dissections have also been reported following isometric or extreme exercise, [134][135][136][137][138] reported in 11.9% of cases in a recent prospective series 19 and occurring more commonly in men. 92 A mechanism linked to increased coronary wall shear stress has been proposed.…”

Spontaneous Coronary Artery Dissection in a Transplanted Heart

“…There have been a few cases of SCAD in liver and kidney transplant recipients. 7 , 8 , 9 The use of immunosuppressant agents such as calcineurin inhibitors and high-dose steroids is a common factor in these cases. Although associations have been reported, there is a lack of supportive data.…”

Disección coronaria espontánea en paciente trasplantada de corazón

“…Los inhibidores de la calcineurina (ICN), uno de los pilares del tratamiento inmunosupresor, exhiben una variedad de efectos secundarios sobre la vasculatura, tales como: vasoconstricción aguda; disfunción endotelial, con aumento de la liberación de sustancias vasoconstrictoras; aumento del tono simpático, producción de radicales libres derivados del oxígeno y un estado proinflamatorio 6 . Nuestra paciente recibía el ICN tacrolimus y, como ha sido postulado previamente 4,5 , no es posible descartar que su uso crónico haya contribuido, a través de estos efectos, a desarrollar la DCE.…”

“…La arteria coronaria más comprometida es la descendente anterior (ADA) 2,3 . En pacientes trasplantados la DCE es una condición extremadamente rara, habiéndose descrito sólo en 3 pacientes (2 trasplantados renales y 1 hepático), en quienes se plantea una posible relación con el uso de anticalcineurínicos 4,5 . El objetivo de este trabajo es comunicar el primer caso de DCE en una receptora de trasplante cardíaco (TxC).…”