Myocardial reinfarction by subacute stent thrombosis in a patient with cutaneous non Hodgkin lymphoma

Introduction: We report the case of a 65 year old female patient with history of cutaneous non-Hodgkin lymphoma, undergoing chronic systemic corticosteroid therapy, send from a territorial hospital with acute extensive anterior myocardial infarction (STEMI), by subacute occlusion of the middle left anterior descendent (LAD) coronary artery, who underwent percutaneous revascularization with stent, followed by reinfarction in the same territory, 72 hours aft er admission, due to subacute stent thrombosis, successfully corrected in an interventional manner (aspiration thrombectomy and balloon angioplasty), with subsequent favorable outcome. Methods: On admission the patient was hemodynamically stable, with present chest pain, positive ECG for extensive anterior STEMI, abnormal wall motion in the anterior territory and moderately reduced LVEF. Emergency coronary angiography revealed LADII subacute occlusion and 75% stenosis on the other vessels, with conservative treatment indication. Bare-metal stent was implanted in LADII with good outcome. 72 hours after angioplasty, when Heparin therapy was stopped, the patient had angina and ECG criteria for reinfarction in the anterior territory. Emergency coronary reassessment showed stent thrombosis. Aft er aspiration thrombectomy, Heparin iv. bolus therapy and GPIIb/ IIIa inhibitor (Eptifi batide) iv. administration, balloon angioplasty was performed, with artery recanalization and TIMI 3 distal fl ow. Results: The patient’s evolution was favorable, with symptoms relief, normalization of myocardial cytolytic enzymes, without arrhythmic events until discharge. In order to prevent stent recurrent thrombosis, we opted for dual antiplatelet therapy with Aspirin and Ticagrelor, instead initial therapy with Aspirin and Clopidogrel, and chronic oral anticoagulation (Acenocumarol). We also recommended expert medical reassessment of hematologic associated disorder and further reevaluation of systemic corticosteroid therapy indication. Conclusions: Although rare, stent thrombosis remains a severe complication aft er stent implantation, owing to its high mortality. Several factors are associated with an increased risk of stent thrombosis, including the procedure itself, patient and lesion characteristics, the response to antiplatelet therapy. The present case illustrates the occurrence of such complication, early, in a patient suff ering a major coronary event, incidents occurring in a particular context, given the suspected pro thrombotic status, caused by the associated hematologic disorder, plus the hypothesis of resistance or hyporesponsiveness to Clopidogrel, in aggregate these factors requiring a particular, multidisciplinary case management.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)