Key result
Immunosuppressive therapy improves non-atherosclerotic acute MI driven by systemic sclerosis coronary arteritis.
Why the study?
Although cardiac involvement in systemic sclerosis is relatively common, it frequently remains clinically silent and underdiagnosed.
Inflammatory etiologies such as systemic sclerosis should be considered in atypical acute coronary syndromes, particularly in patients lacking traditional cardiovascular risk factors.
Raises possibility of inflammatory arteritis causing MI in systemic sclerosis; hypothesis-generating for immunosuppression.
Systemic sclerosis is a rare autoimmune connective tissue disease characterized by progressive fibrosis and widespread microvascular involvement. Although cardiac involvement is relatively common, it frequently remains clinically silent and underdiagnosed. We report an exceptional case of inflammatory coronary arteritis revealing systemic sclerosis, complicated by an acute myocardial infarction in a 64-year-old woman with no cardiovascular risk factors. Coronary angiography revealed thrombotic occlusion without any atherosclerotic lesions, suggesting a non-atherosclerotic etiology. The subsequent development of pericarditis and joint pain, combined with positive immunological markers (anti-Scl70 and anti-RNA polymerase III antibodies), led to the diagnosis of systemic sclerosis. Immunosuppressive therapy resulted in significant clinical improvement. This case underscores the importance of considering inflammatory etiologies in atypical acute coronary syndromes, particularly in the absence of traditional risk factors, and highlights the need for an integrated diagnostic approach in systemic inflammatory contexts.
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Sarsari et al. (2026) studied this question. Inflammatory coronary arteritis from systemic sclerosis can cause acute myocardial infarction without atherosclerosis, with immunosuppressive therapy yielding significant improvement.
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