Liu RF, Gao XY, Liang SW, Zhao HQ. Antithrombotic treatment strategy for patients with coronary artery ectasia and acute myocardial infarction: A case report. World J Clin Cases 2022; 10(12): 3936-3943 [PMID: 35647140 DOI: 10.12998/wjcc.v10.i12.3936]
Corresponding Author of This Article
Hui-Qiang Zhao, MD, Professor, Department of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing 100050, China. huiqiangzhao123456@163.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rui-Feng Liu, Xiang-Yu Gao, Si-Wen Liang, Hui-Qiang Zhao, Department of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
Author contributions: Zhao HQ and Liu RF contributed to collecting clinical details; Gao XY and Liang SW contributed to drafting and writing the manuscript; Zhao HQ and Liu RF made substantial contribution to manuscript revision; all authors reviewed and approved the final manuscript.
Supported byNational Natural Science Foundation of China, No. 81600276.
Informed consent statement: This patient agreed for all of his treatment and was informed that his medical information would be analyzed and published by us for the scientific purpose.
Conflict-of-interest statement: The authors report no relationships that could be construed as a conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Qiang Zhao, MD, Professor, Department of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing 100050, China. huiqiangzhao123456@163.com
Received: October 17, 2021 Peer-review started: October 17, 2021 First decision: January 11, 2022 Revised: January 19, 2022 Accepted: March 6, 2022 Article in press: March 6, 2022 Published online: April 26, 2022 Processing time: 185 Days and 20.5 Hours
Abstract
BACKGROUND
There is no consensus on the antithrombotic treatment strategy for patients with coronary artery ectasia (CAE).
CASE SUMMARY
This case reports the dynamic observation of a patient for 48 mo after a diagnosis of CAE with acute myocardial infarction (AMI). The first antithrombotic agents used were aspirin (100 mg/d) and clopidogrel (75 mg/d). During the sixth month of observation, a second AMI occurred involving the same culprit vessel; therefore, antithrombotic agents were changed to aspirin (100 mg/d) and ticagrelor (90 mg twice per day). Twelve months after the second AMI, an attempt to reduce the dosage ticagrelor failed; therefore the original dose was continued. The CAE was relatively stable during the following 4 years.
CONCLUSION
This case indicates that a combination of aspirin and ticagrelor may be more effective for CAE patients with AMI than aspirin and clopidogrel.
Core Tip: Here we present an antithrombotic strategy for patients with coronary artery ectasia as follows: (1) For patients with acute coronary syndrome (ACS), dual antiplatelet therapy (DAPT) is recommended with the combination of aspirin and ticagrelor; further, more aggressive treatment combining DAPT with an anti-coagulant agent should be considered for patients with a high risk of thrombosis; and (2) ACS patients after 12 mo or patients without ACS should be routinely placed on aspirin as primary prevention, and DAPT would be a better choice if the patient does not have a high risk of bleeding.
