Myocardial Infarction Potentially Caused by Erosion and Spasm.

A 49-year old woman presented to the emergency department with chest pain and was diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI). An emergent coronary angiogram exhibited mild stenosis in the proximal left anterior descending (LAD) artery after the administration of intracoronary nitroglycerin (Picture A). Further examination of the lesion by optical coherence tomography (OCT) revealed intraluminal thrombi superimposed on an intact fibrous cap plaque, categorized as OCT-defined plaque erosion (Picture B). Given the non-significant stenosis at the culprit lesion, interventional procedures were deferred. One week later, an acetylcholine spasm provocation test was performed, which induced a severe spasm in the LAD at the site of OCT-defined plaque erosion (Picture C). Shin et al. (1) suggested the potential role of antiplatelet therapy in cases of coronary spasm with OCT-defined plaque erosion. Accordingly, the patient was treated with aspirin along with calcium channel blockers. The patient remained free of recurrent angina and cardiac events at 8 months from discharge.

Picture.

The authors state that they have no Conflict of Interest (COI).