Key result
Intracoronary imaging identified coronary embolism as the cause of myocardial infarction in a patient with non-compaction cardiomyopathy, guiding a switch to warfarin with asymptomatic recovery at 1 year.
Why the study?
Coronary embolism is a rare cause of MI, emphasizing the need to highlight the role of intracoronary imaging to identify the underlying pathophysiological mechanism.
Case Report (n=1)
Intracoronary imaging is crucial in identifying coronary embolism as a cause of MI, particularly in rare conditions like left ventricular non-compaction cardiomyopathy, as it directly alters antithrombotic management.
May guide intracoronary imaging and anticoagulation in MI with non-compaction cardiomyopathy; hypothesis-generating from single case.
BACKGROUND: Coronary embolism is a rare cause of myocardial infarction (MI). We present a case report which emphasizes the importance of intracoronary imaging in these cases to identify the pathophysiological mechanism of MI. CASE SUMMARY: A 53-year-old male with no past medical history presented to the hospital with typical angina. Electrocardiogram and serum troponin I level trend confirmed non-ST-elevation myocardial infarction. Coronary angiography showed no evidence of any obstructive coronary artery disease, but two small thrombi were noted in the distal first obtuse marginal branch. Optical coherence tomography imaging confirmed this finding in absence of any underlying atherosclerotic plaque rupture or erosion. Cardiac magnetic resonance imaging revealed the diagnosis of non-compaction cardiomyopathy with severely depressed left ventricular function. Transmural MI was revealed by late gadolinium enhancement in the mid-lateral wall. Based on the pathophysiology of the MI confirmed by intracoronary imaging, antiplatelet medications were discontinued, and the patient was discharged on warfarin. Medical therapy was initiated for his cardiomyopathy. The patient recovered well and was asymptomatic at 1-year follow-up visit. DISCUSSION: Intracoronary imaging plays an important role to supplement coronary angiography to confirm the pathophysiology of MI in coronary embolism cases. This is important as it alters management in these patients.
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Dhawan et al. (2021) conducted a case report in Myocardial infarction secondary to coronary embolus and left ventricular non-compaction cardiomyopathy (n=1). Intracoronary imaging (Optical coherence tomography) and warfarin therapy was evaluated on Clinical recovery and symptom status. Intracoronary imaging identified coronary embolism as the cause of myocardial infarction in a patient with non-compaction cardiomyopathy, guiding a switch to warfarin with asymptomatic recovery at 1 year.
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