Anlotinib‑induced acute myocardial infarction: A case report and literature review

Figures

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  Figure 1. Flow chart of the treatment process. The patient initially received radical resection in June 2015 and was diagnosed with T3N0M0 (stage IIb) squamous cell carcinoma. Further treatment was administered following a CT scan indicating thoracic vertebral metastasis in March 2017, which subsequently resulted in the patient receiving anlotinib, and the development of AMI 14 months later. PD, progressive disease; PR, partial response; SD, stable disease; CR, complete response; AMI, acute myocardial infarction; PCI, percutaneous coronary intervention.

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  Figure 2. Initial electrocardiogram demonstrating atrial fibrillation, ST elevation in AVR and V1 (AVR>V1) and ST depression in V2 to V6, II, III and AVF.

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  Figure 3. Coronary angiography. (A) Initial coronary angiography indicating 85% proximal stenosis of the left major coronary artery (arrowhead). (B) A drug-eluting stent was added to the left major coronary artery lesion 30 min subsequent to coronary angiography (arrowhead).

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  Figure 4. Electrocardiogram after half an hour of percutaneous coronary intervention demonstrating sinus rhythm and all abnormal leads were back to normal.

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  Figure 5. Analytical process of identifying the cause of AMI by anlotinib. CHD, hypertension, diabetes DM and hyperlipidemia were not exhibited by the patient. The patient received surgery, chemotherapy, radiotherapy and targeted drug therapy with anlotinib for the treatment of squamous cell carcinoma. The possibility of AMI following surgery, chemotherapy and radiotherapy was excluded. AMI was therefore attributed to anlotinib. ‘x’ indicates that the patient did not develop the disease/disorder or did not receive the type of treatment. ‘Δ’ indicates that treatment with cisplatin was not able to induce AMI due to this effect being beyond its drug action cycle. ‘?’ indicates the probabitiy of taxanes and radiotherapy causing AMI, which was uncertain. ‘√’ indicated that this caused AMI. CHD, coronary heart disease; DM, diabetes mellitus; AMI, acute myocardial infarction.