Alqam Bilal, Medrek Sarah
Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Division of Pulmonary, Critical Care, Sleep Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Respir Med Case Rep. 2025 Feb 27;54:102184. doi: 10.1016/j.rmcr.2025.102184. eCollection 2025.
An 81-year-old man with a history of interstitial lung disease attributed to idiopathic pulmonary fibrosis, severe aortic stenosis, and stable coronary artery disease was started on inhaled treprostinil for pulmonary hypertension associated with interstitial lung disease to optimize hemodynamics prior to the valve replacement procedure. However, two days after starting this treatment, the patient presented with an inferior-posterior ST elevation myocardial infarction. Urgent coronary angiography revealed a 95 % proximal right coronary artery stenosis, successfully treated with percutaneous coronary intervention and drug-eluting stent placement. This case raises a question of whether there could be a potential association between inhaled treprostinil initiation and acute myocardial infarction in patients with underlying coronary artery disease. With the documented stability of the patient's coronary artery disease prior to medication initiation, it is plausible to question whether treprostinil may have played a role in plaque destabilization.
一名81岁男性，有特发性肺纤维化所致间质性肺疾病、严重主动脉瓣狭窄和稳定型冠状动脉疾病病史，因间质性肺疾病相关的肺动脉高压开始吸入曲前列尼尔治疗，以便在瓣膜置换手术前优化血流动力学。然而，开始这种治疗两天后，患者出现下后壁ST段抬高型心肌梗死。紧急冠状动脉造影显示右冠状动脉近端狭窄95%，经皮冠状动脉介入治疗并植入药物洗脱支架后成功治疗。该病例提出了一个问题，即对于患有潜在冠状动脉疾病的患者，开始吸入曲前列尼尔与急性心肌梗死之间是否可能存在潜在关联。鉴于用药前患者冠状动脉疾病已记录在案的稳定性，质疑曲前列尼尔是否可能在斑块不稳定中起作用是有道理的。
