Oktaviono Yudi Her, Hutomo Suryo Ardi, Al-Farabi Makhyan Jibril
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia.
School of Healthcare Managemenent, University College London, Bloomsbury, London, United Kingdom.
Medicine (Baltimore). 2020 Feb;99(9):e19288. doi: 10.1097/MD.0000000000019288.
Acute myocardial infarction is the leading cause of mortality and morbidity in a patient with polycythemia vera (PV). However, the benefit of various percutaneous coronary intervention (PCI) technique on the patient with PV is relatively unexplored.
A 46-year-old woman presented to the primary hospital complained about new-onset typical chest pain. Echocardiography examination showed inferior ST-elevation myocardial infarction (STEMIs) and increased cardiac markers. Complete blood count showed elevated hemoglobin, white blood cell, and platelet.
Coronary angiography revealed simultaneous total occlusion at proximal right coronary artery (RCA) and also at proximal left anterior descending (LAD) artery. Elevated hemoglobin and hematocrit with JAK2 mutation establish the diagnosis of PV.
We performed multi-vessel primary PCI by using direct stenting in RCA and aspiration thrombectomy in LAD after failed with balloon dilatation and direct stenting method. This procedure resulted in thrombolysis in myocardial infarction (TIMI)-3 flow in both coronary arteries. However, the no-reflow phenomenon occurred in the LAD, followed by ventricular fibrillation. After several attempts of resuscitation, thrombus aspiration, and low-dose intracoronary thrombolysis, the patient was returned to spontaneous circulation. The patient then received dual antiplatelet and cytoreductive therapy.
The patient clinical condition and laboratory finding were improved, and the patient was discharged on the 7th day after PCI.
Cardiologist should be aware of the no-reflow phenomenon risk in the patient with PV and STEMI. Direct stenting, intracoronary thrombectomy, and thrombolysis are preferable instead of balloon dilatation for PCI technique in this patient.
急性心肌梗死是真性红细胞增多症（PV）患者死亡和发病的主要原因。然而，各种经皮冠状动脉介入治疗（PCI）技术对PV患者的益处相对尚未得到充分探索。
一名46岁女性到基层医院就诊，主诉新发典型胸痛。超声心动图检查显示下壁ST段抬高型心肌梗死（STEMIs）且心肌标志物升高。全血细胞计数显示血红蛋白、白细胞和血小板升高。
冠状动脉造影显示右冠状动脉（RCA）近端和左前降支（LAD）近端同时完全闭塞。血红蛋白和血细胞比容升高以及JAK2突变确诊为PV。
我们在RCA采用直接支架置入术，在LAD采用球囊扩张和直接支架置入术失败后进行了血栓抽吸术，实施了多支血管直接PCI。该操作使两条冠状动脉均达到心肌梗死溶栓（TIMI）-3级血流。然而，LAD出现了无复流现象，随后发生心室颤动。经过多次复苏、血栓抽吸和低剂量冠状动脉内溶栓尝试后，患者恢复自主循环。然后患者接受了双联抗血小板和减细胞治疗。
患者的临床状况和实验室检查结果得到改善，在PCI术后第7天出院。
心脏病专家应意识到PV和STEMI患者存在无复流现象的风险。对于该患者的PCI技术，直接支架置入术、冠状动脉内血栓切除术和溶栓术优于球囊扩张术。
