Key result
PAI-1 4G/4G mutation and marijuana use linked to AMI from complete LCx occlusion.
Why the study?
NSTE-ACS resulting from genetic thrombophilias such as PAI-1 polymorphisms is extremely uncommon.
Case Report (n=1)
This case highlights the rare association between myocardial infarction and the homozygous PAI-1 4G/4G polymorphism, emphasizing the need for thrombophilia testing in young ACS patients without conventional risk factors.
Should not change practice in young ACS; leaves open whether PAI-1 4G/4G testing aids evaluation.
Non-ST-elevation acute coronary syndrome (NSTE-ACS) resulting from genetic thrombophilias such as plasminogen activator inhibitor-1 (PAI-1) polymorphisms is extremely uncommon. We report the case of a 47-year-old male with no significant past medical history, aside from marijuana use, who presented with chest pain and elevated troponin levels. Coronary angiography demonstrated a thrombotic 100% occlusion of the left circumflex artery. A hypercoagulability workup revealed a homozygous 4G/4G PAI-1 gene polymorphism, consistent with an increased thrombotic predisposition, with marijuana use serving as a possible trigger. The patient was treated with aspirin, clopidogrel, and apixaban. This case illustrates a rare association between myocardial infarction and the PAI-1 4G/4G polymorphism and underscores the importance of considering thrombophilia testing in young patients with ACS who lack conventional cardiovascular risk factors.
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Manasrah et al. (2025) conducted a case report in Non-ST-elevation acute coronary syndrome (n=1). Homozygous PAI-1 4G/4G mutation was evaluated. A 47-year-old male with a homozygous PAI-1 4G/4G mutation and intermittent marijuana use developed an acute myocardial infarction due to a 100% thrombotic occlusion of the left circumflex artery.
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