Division of Cardiology, Yokohama City University Medical Center, Japan.
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Japan.
Intern Med. 2021 Aug 15;60(16):2639-2643. doi: 10.2169/internalmedicine.6095-20. Epub 2021 Mar 15.
We encountered a case of ST-segment elevation myocardial infarction (STEMI) as the first clinical manifestation of essential thrombocythemia (ET). Platelet function tests revealed high thrombogenicity during primary percutaneous coronary intervention compared with general cardiovascular patients, whereas the platelet function two weeks after admission was effectively suppressed by dual antiplatelet therapy. The patient, who lacked cytoreduction, suffered from recurrent STEMI because of poor compliance with antiplatelet drugs. The risk of acute coronary occlusion may be high during the acute phase of STEMI in ET patients because of high thrombogenicity. Insufficient antiplatelet therapy and no cytoreduction are also risk factors for recurrent coronary events.
我们遇到了一例以 ST 段抬高型心肌梗死（STEMI）为首发表现的原发性血小板增多症（ET）。与一般心血管病患者相比，在经皮冠状动脉介入治疗（PCI）的急性期，血小板功能检测显示其具有较高的血栓形成性，而入院后两周的血小板功能通过双联抗血小板治疗得到有效抑制。该患者未行细胞减少治疗，由于抗血小板药物的依从性差，反复发生 STEMI。由于高血栓形成性，ET 患者 STEMI 的急性期发生急性冠状动脉闭塞的风险可能较高。抗血小板治疗不足和未行细胞减少治疗也是复发性冠脉事件的危险因素。
