Subacute Stent Thrombosis After Primary Percutaneous Coronary Intervention in a Middle-Aged Anabolic Steroid–Abusing Bodybuilder

Figures

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  Figure 1. Right Coronary Angiography and Optical Coherence Tomography Images of right coronary angiography (RCAG) and optical coherence tomography (OCT) at pre-percutaneous coronary intervention (PCI) on admission (A), post-PCI on admission (B), and subacute thrombosis on day 4 after admission (C). OCT images were obtained proximal (1), mid (2), and distal (3) to the sites of the culprit lesion. Stent was implanted in the lesion (1 to 3). White arrowhead indicates the site of plaque rupture. White asterisks indicate the thrombus formation.

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  Figure 2. Representative Computed Tomography Images Showing Remarkable Muscular Appearance

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  Figure 3. Analysis of Oxandrolone in Human Plasma by UFLC-MS/MS (A) The enhanced product ion spectra obtained from the control human plasma sample spiked with 0.5 ng/ml of oxandrolone (upper) and the patient plasma sample (lower). (B) Multiple reaction monitoring chromatograms obtained from the control human plasma sample (upper), the control human plasma spiked with 1.0 ng/ml of oxandrolone (middle), and the patient plasma sample (lower). Red arrows indicate the presence of oxandrolone in the plasma. ESI = electrospray ionization; [M+H]+ = protonated ion; m/z = mass to charge; UFLC-MS/MS = ultra-fast liquid chromatography–tandem mass spectrometry.

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  Supplemental Figure 1. Electrocardiograms showing a complete atrio-ventricular block with ST-segment elevations in inferior leads (A) on the day of arrival and (B) at subacute thrombosis on day 4 after admission.