Pontificia Universidad Javeriana Departmento de Medicina Interna, Bogota, Colombia.
Pontificia Universidad Javeriana, Medicina Interna, Unidad de Reumatología, Bogota, Colombia.
Colomb Med (Cali). 2023 Jun 28;54(2):e5005466. doi: 10.25100/cm.v54i2.5466. eCollection 2023 Apr-Jun.
A 61-year-old male patient with uncontrolled rheumatoid arthritis presented acute coronary syndrome on three occasions, less than 48 hours after infliximab infusion.
He presented with ST-elevation myocardial infarction on two occasions and non-ST-elevation acute coronary syndrome on one, with the identification of multivessel coronary disease.
Coronary intervention was performed with thrombus aspiration, medicated stent implantation, medicated balloon angioplasty, discontinuation of infliximab, and modification and optimization of cardiovascular pharmacological management.
Patients with rheumatoid arthritis have subclinical cardiovascular disease and increased cardiovascular risk. The evidence regarding the relationship between infliximab and ischemic heart disease is controversial. A wide clinical spectrum of cardiac involvement with infliximab infusion is found in case reports, ranging from stable angina to ST-segment elevation acute coronary syndrome. The pathophysiology is not elucidated, with hypotheses proposing plaque rupture, allergic reactions, and vasoconstriction as possible disease mechanisms. The direct association between infliximab infusion and acute coronary syndrome needs more clinical research to optimize the management and prognosis of patients presenting with this type of complication.
一名 61 岁男性患者患有未控制的类风湿关节炎，在接受英夫利昔单抗输注后不到 48 小时，出现了三次急性冠状动脉综合征。
他两次出现 ST 段抬高型心肌梗死，一次出现非 ST 段抬高型急性冠状动脉综合征，伴有多血管性冠状动脉疾病的识别。
进行了冠状动脉介入治疗，包括血栓抽吸、药物洗脱支架植入、药物球囊血管成形术、停用英夫利昔单抗以及心血管药物管理的修改和优化。
类风湿关节炎患者存在亚临床心血管疾病和增加的心血管风险。关于英夫利昔单抗与缺血性心脏病之间关系的证据存在争议。在病例报告中发现了英夫利昔单抗输注与多种心脏受累相关的广泛临床谱，从稳定型心绞痛到 ST 段抬高型急性冠状动脉综合征不等。其病理生理学尚未阐明，假设提出斑块破裂、过敏反应和血管收缩可能是疾病机制。英夫利昔单抗输注与急性冠状动脉综合征之间的直接关联需要更多的临床研究，以优化出现这种并发症的患者的管理和预后。
