Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2022; 10(32): 11955-11966
Published online Nov 16, 2022. doi: 10.12998/wjcc.v10.i32.11955
What is responsible for acute myocardial infarction in combination with aplastic anemia? A case report and literature review
Ya-Nan Zhao, Wei-Wei Chen, Xiao-Yu Yan, Kun Liu, Guo-Hui Liu, Ping Yang
Ya-Nan Zhao, Wei-Wei Chen, Xiao-Yu Yan, Kun Liu, Guo-Hui Liu, Ping Yang, Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130000, Jilin Province, China
Ya-Nan Zhao, Wei-Wei Chen, Xiao-Yu Yan, Kun Liu, Guo-Hui Liu, Ping Yang, Department of Cardiology, Jilin Provincial Cardiovascular Research Institute, Changchun 130000, Jilin Province, China
Ya-Nan Zhao, Wei-Wei Chen, Xiao-Yu Yan, Kun Liu, Guo-Hui Liu, Ping Yang, Department of Cardiology, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130000, Jilin Province, China
Author contributions: Chen WW and Zhao YN wrote the first draft and corrected the manuscript; Zhao YN, Yan XY, and Liu K collected the data; Liu GH and Yang P revised the manuscript and figures; all authors read and approved the final manuscript.
Supported by the project from Provincial Science and Technology Department, No. 2019SC0012.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no 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: Ping Yang, Doctor, PhD, Director, Professor, Department of Cardiology, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun 130000, Jilin Province, China. pyang@jlu.edu.cn
Received: July 13, 2022
Peer-review started: July 13, 2022
First decision: September 25, 2022
Revised: October 1, 2022
Accepted: October 18, 2022
Article in press: October 18, 2022
Published online: November 16, 2022
Processing time: 117 Days and 18.9 Hours
Abstract
BACKGROUND

Aplastic anemia (AA) complicated with myocardial infarction (MI) is rare and associated with poor prognosis. Here, we present a case of AA with recurrent acute MI (AMI) in a patient treated with cyclosporine A (CsA) and stanozolol. In this patient, we suspect the long-term use of medication linked to platelets hyperfunction.

CASE SUMMARY

In 2017, a 45-year-old man was rushed to the emergency department of China-Japan Union Hospital due to precordial pain for 5 h. Based on his symptoms, medical history, blood tests, and findings from coronary angiography (CAG), the patient was diagnosed with acute anterior wall, ST-segment elevated MI, Killip II grade, AA, and dyslipidemia. In 2021, the patient was readmitted to the hospital for 2 h due to chest pain. Because the patient’s platelet count was 30 × 109/L and he had severe thrombocytopenia, we performed CAG following platelet transfusion. Optical coherence tomography revealed lipid plaque and thrombus mass in his right coronary artery. The antithrombotic approach was adjusted to employ only anticoagulants (factor Xa inhibitors) and adenosine diphosphate inhibitors (clopidogrel) after assessing the risk of bleeding/thrombotic events. Long-term follow-up revealed that the patient had made a good recovery.

CONCLUSION

Patients with AA should be closely monitored for the risk of thrombosis and cardiovascular events, particularly when taking stanozolol or CsA for an extended period of time.

Keywords: Aplastic anemia, Myocardial infarction, Cyclosporine A, Stanozolol, Percutaneous coronary intervention, Case report

Core Tip: Acute myocardial infarction combined with aplastic anemia (AA) has been reported but not well studied. The medicine used to treat AA in this patient may have caused coronary artery and left ventricular thrombosis. Coronary intervention, particularly stenting, is still controversial in this rare clinical scenario. Thus far, no specific management regarding this disease, especially for intracoronary findings, has been reported. Early revascularization may be the most important factor in improving patient prognosis.