Acute myocardial infarction following sequential multi-vessel occlusion in a case of polycythemia vera

Okabe, Hiroki; Sonoda, Shinjo; Abe, Kōji; Doi, Hideki; Matsumura, Toshiyuki

doi:10.1016/j.jccase.2019.06.001

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…Multiple coronary thrombosis may be encountered in cases of constitutional or acquired thrombophilia such as in essential thrombocythemia [ 6 ], polycythemia vera [ 7 ] or hyperhomocysteinemia [ 8 ]. Other identifiable predisposing factors include coronary ectasia [ 9 ], vasospasm [ 10 ]and cocaine use [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Acute double coronary occlusion and its misleading presentation: An unusual case report

Assamti

Benahmed

Ismaili

et al. 2022

Annals of Medicine &Amp; Surgery

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Acute simultaneous double coronary occlusion is an extremely rare condition with an unspecific presentation. We report a case of a 57-year-old male, with undiagnosed diabetes mellitus, presenting with acute epigastralgia and vomiting associated with dynamic electrocardiographic changes. He was hemodynamically stable. Emergency coronary angiogram showed a total occlusion of both proximal left circumflex and mid left anterior descending coronary artery. Since the EKG indicated minimal ST-segment elevation in the lateral leads as well as an ST depression in the inferior leads, we performed a percutaneous coronary intervention of both the LCx and LAD, using a floppy guidewire. Similar cases of multiple simultaneous coronary occlusions are reported in literature, yet the accurate incidence and physiopathology of this occurrence is still uncertain. Although this condition is associated with serious complications, our case evolved favorably due to prompt management.

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Section: Discussionmentioning

confidence: 99%

Acute double coronary occlusion and its misleading presentation: An unusual case report

Assamti

Benahmed

Ismaili

et al. 2022

Annals of Medicine &Amp; Surgery

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“…In addition to the aforementioned clinical findings, splenomegaly and increases in serum lactate dehydrogenase and neuron-specific enolase levels can be observed in patients with PV (8). Okabe et al (9) reported a case of myocardial infarction, even after proper stent placement, and many thromboses reformed on the stent, accompanied by significant elevation of the platelet count and hematocrit level. Bone marrow aspiration revealed bone marrow hyperplasia.…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction Followed by Cerebral Hemorrhagic Infarction in Polycythemia Vera: Case Report and Literature Review

Shao

Liu

Qin

et al. 2021

Front. Cardiovasc. Med.

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A 60-year-old man presented to our emergency room with severe chest pain. Based on the electrocardiogram and elevated serum troponin T levels, acute coronary syndrome was suspected. Coronary angiography revealed total occlusion of the middle of the left anterior descending coronary artery. However, blood cell count abnormalities were not of concern. Twelve days later, the patient developed hemorrhagic infarction in the right parieto-occipital lobe. Acute coronary syndrome and cerebral hemorrhagic infarction were primarily caused by thrombus formation due to polycythemia vera (PV), based on the presence of increased blood consistency on admission. PV was diagnosed after bone marrow biopsy and genetic testing. The patient was treated with descending cell and antiplatelet therapy. Our case highlights the importance of the urgent identification of PV. When acute myocardial infarction occurs in patients with no significant risk factors for cardiovascular disease, blood routine abnormalities should be paid close attention to. If PV was diagnosed as early as possible, thrombotic and hemorrhagic complications could be prevented in the early stages.

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“…Polycythemia is a state of hemoglobin overproduction, and it is generally divided into 2 types: secondary polycythemia, the common type, in which the overproduction of hemoglobin is driven by a hypoxemic trigger (such as smoking), and primary polycythemia (polycythemia vera, PV), which is a rare myeloproliferative disease [11]. Of the 2 types, PV was shown to be associated with ACS in several reports [12][13][14][15]. The mechanism is considered to be thrombosis due to hyperviscosity of the blood [16]; however, in a case report of an STEMI in a PV patient with normal hematocrit, optical coherence tomography suggested a different mechanism of coronary intimal proliferation and exfoliation [17].…”

Section: Discussionmentioning

confidence: 99%

Association of Polycythemia with Outcomes of Acute Coronary Syndrome

et al. 2021

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Background: Polycythemia has not been extensively studied for its impact on acute coronary syndrome (ACS) outcomes. A previous study reported only 30-day outcomes to be worse in these patients. Methods: Data from the ACS Israeli survey between 2000 and 2018 were utilized to compare between 3 groups of patients with ACS: anemic group (hemoglobin <12 g/dL for women and <12.5 g/dL for men), normal hemoglobin group, and polycythemic group (>16 g/dL and >16.5 g/dL, respectively). Measured outcomes included 30-day major adverse cardiac events (MACE comprising all-cause mortality, recurrent ACS, need for urgent revascularization, and stroke) and 1- and 5-year all-cause mortality. Results: Of 14,746 ACS patients, 10,752 (72.9%) had normal hemoglobin levels, 3,492 (23.7%) were anemic, and 502 (3.4%) were polycythemic. In comparison with normal and anemic patients, polycythemic patients were younger (55.9 ± 10.5 vs. 61.9 ± 12.4 and 71.1 ± 12.2 for anemic, respectively, p < 0.001 for both), more frequently men (93.8% vs. 81.3% and 63.1%, respectively, p < 0.001), and less likely diabetic or hypertensive. Upon adjustment to baseline characteristics, compared with normal hemoglobin, polycythemia was not independently associated with 30-day MACE or 1-year mortality, but it was independently associated with higher risk for 5-year mortality (HR 1.76, 95% CI: 1.19–2.59, p = 0.005). Similar results were observed after propensity score matching. Conclusions: Although younger and with fewer comorbidities, polycythemic ACS patients are at increased risk for long-term all-cause mortality. Further study of this association is warranted to understand the causes and possibly to improve the outcomes of these patients.

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Acute myocardial infarction following sequential multi-vessel occlusion in a case of polycythemia vera

Cited by 5 publications

References 7 publications

Acute double coronary occlusion and its misleading presentation: An unusual case report

Acute double coronary occlusion and its misleading presentation: An unusual case report

Acute Myocardial Infarction Followed by Cerebral Hemorrhagic Infarction in Polycythemia Vera: Case Report and Literature Review

Association of Polycythemia with Outcomes of Acute Coronary Syndrome

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