Iodinated contrast media induced Kounis syndrome during coronary angiogram: a life-threatening clinical dilemma

Abstract

Kounis syndrome (KS) is a well-documented hypersensitivity vasospastic reaction induced by a variety of triggers. Clinical presentation ranges from non-specific symptoms such as dizziness and nausea to myocardial infarction. Many cases of KS were reported after the use of iodinated contrast media, mainly during radiological procedures. This report describes the case of a 46-year-old man developing coronary vasospasm and anaphylactic shock at the end of percutaneous coronary intervention. Occurrence of such pathology while performing coronary angiogram is a tricky situation for the invasive cardiologist. It requires recognising a rare syndrome and interrupting the procedure to avoid extra use of contrast media even in presence of severe coronary lesions due to vasospasm. Every interventionalist should be aware of such a presentation to recognise and react promptly when facing a potentially life-threatening clinical dilemma.

Development of a risk score model for the prediction of patients needing percutaneous coronary intervention

“…As known, CAG is an invasive procedure, and patients may be allergic to the contrast agent, which will cause severe hypersensitivity reactions and can be life-threatening. 11 Many scholars have explored the influencing factors related to the degree of stenosis in patients with CHD, suggesting that the history of diabetes, blood glucose level, white blood cell count, serum troponin, fibrinogen level, fibrinogen to albumin ratio, BNP level, total bilirubin, and uric acid level were independent factors on the severity of coronary artery lesions. [12][13][14][15][16][17][18] However, to date, there is still a lack of non-invasive and efficient methods to predict the need for PCI in patients with coronary artery disease.…”

“…Secondly, oxidative stress exacerbates macrovascular damage in diabetic patients, namely by inducing the production of reactive oxygen species (ROS), which subsequently damages the endothelial system. 11 Hyperglycemia in diabetic patients also promotes protein kinase C activation and diacylglycerol production, both accelerate the development of atherosclerosis by promoting inflammatory mediators and smooth muscle cell recruitment. It has been shown that the risk of developing CHD in diabetes is highest at any age and is mainly associated with insulin resistance, type 2 diabetes, and metabolic syndrome.…”

“…However, CAG is required to confirm the diagnosis of CHD and the degree of coronary stenosis to determine whether the patient needs to undergo PCI. As known, CAG is an invasive procedure, and patients may be allergic to the contrast agent, which will cause severe hypersensitivity reactions and can be life‐threatening 11 . Many scholars have explored the influencing factors related to the degree of stenosis in patients with CHD, suggesting that the history of diabetes, blood glucose level, white blood cell count, serum troponin, fibrinogen level, fibrinogen to albumin ratio, BNP level, total bilirubin, and uric acid level were independent factors on the severity of coronary artery lesions 12–18 .…”

“…First, elevated blood glucose is a major determinant of arterial stiffness, and chronic hyperglycemia is associated with the accumulation of advanced glycosylation end products (AGEs), which contribute to atherosclerosis and increase the severity of coronary artery lesions. Secondly, oxidative stress exacerbates macrovascular damage in diabetic patients, namely by inducing the production of reactive oxygen species (ROS), which subsequently damages the endothelial system 11 . Hyperglycemia in diabetic patients also promotes protein kinase C activation and diacylglycerol production, both accelerate the development of atherosclerosis by promoting inflammatory mediators and smooth muscle cell recruitment.…”