scholarly journals Uncommon but imperative cause of repeated acute stent thrombosis: Kounis syndrome type III

2021 ◽  
Vol 14 (3) ◽  
pp. e240704
Author(s):  
Shiro Miura ◽  
Takehiro Yamashita ◽  
Masaki Murata ◽  
Nicholas G Kounis
Keyword(s):  
Stent Thrombosis ◽  
Pathological Examination ◽  
Syndrome Type ◽  
Kounis Syndrome ◽  
St Segment Elevation ◽  
Type Iii ◽  
Coronary Syndrome ◽  
St Segment ◽  
History Of ◽  
Acute Stent Thrombosis

A 69-year-old woman with a history of allergic reactions to unknown metals who presented 1 year prior with acute coronary syndrome complicated by acute stent thrombosis (ST) was admitted due to new-onset chest pain during mild exercise. She electively underwent coronary angiography, revealing a newly developed stenosis in the fourth branch of the posterior descending artery, treated with an everolimus-eluting stent. One hour later, she reported of sudden chest tightness and nausea; ECG revealed significant ST-segment elevation in the II, III and aVF leads. We suspected ST-segment elevation myocardial infarction resulting from an allergic reaction (ie, Kounis syndrome type III) and managed it properly by eliminating other potential causes. The tentative diagnosis was confirmed by pathological examination of aspirated materials. Kounis syndrome type III may be a frequently undiagnosed clinical entity, emphasising the importance of pathological examination of aspirated materials when implanting coronary stents and history-taking of allergies to stent metals.

scholarly journals Allergy Associated Myocardial Infarction: A Comprehensive Report of Clinical Presentation, Diagnosis and Management of Kounis Syndrome

Vaccines ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 38
Author(s):  
Anastasios Roumeliotis ◽  
Periklis Davlouros ◽  
Maria Anastasopoulou ◽  
Grigorios Tsigkas ◽  
Ioanna Koniari ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Arteries ◽  
Case Reports ◽  
Type I ◽  
Type Ii ◽  
Kounis Syndrome ◽  
Normal Coronary Arteries ◽  
St Segment Elevation ◽  
Type Iii ◽  
Coronary Syndrome

Kounis syndrome (KS) has been defined as acute coronary syndrome (ACS) in the context of a hypersensitivity reaction. Patients may present with normal coronary arteries (Type I), established coronary artery disease (Type II) or in-stent thrombosis and restenosis (Type III). We searched PubMed until 1 January 2020 for KS case reports. Patients with age <18 years, non-coronary vascular manifestations or without an established diagnosis were excluded. Information regarding patient demographics, medical history, presentation, allergic reaction trigger, angiography, laboratory values and management were extracted from every report. The data were pulled in a combined dataset. From 288 patients with KS, 57.6% had Type I, 24.7% Type II and 6.6% Type III, while 11.1% could not be classified. The mean age was 54.1 years and 70.6% were male. Most presented with a combination of cardiac and allergic symptoms, with medication being the most common trigger. Electrocardiographically, 75.1% had ST segment elevation with only 3.3% demonstrating no abnormalities. Coronary imaging was available in 84.8% of the patients, showing occlusive lesions (32.5%), vascular spasm (16.2%) or normal coronary arteries (51.3%). Revascularization was pursued in 29.4% of the cases. In conclusion, allergic reactions may be complicated by ACS. KS should be considered in the differential diagnosis of myocardial infarction with non-obstructive coronary arteries.

scholarly journals Demographics, practice patterns and long-term outcomes of patients with non–ST-segment elevation acute coronary syndrome in the past two decades: the CREDO-Kyoto Cohort-2 and Cohort-3

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044329
Author(s):  
Yasuaki Takeji ◽  
Hiroki Shiomi ◽  
Takeshi Morimoto ◽  
Yusuke Yoshikawa ◽  
Ryoji Taniguchi ◽  
...  
Keyword(s):  
Stent Thrombosis ◽  
Major Bleeding ◽  
Cardiac Death ◽  
Cardiovascular Death ◽  
Coronary Revascularisation ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
The Past ◽  
St Segment ◽  
Definite Stent Thrombosis

ObjectivesTo evaluate patient characteristics and long-term outcomes in patients with non–ST-segment elevation acute coronary syndrome (NSTEACS) in the past two decades.DesignMulticenter retrospective study.SettingThe Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) Registry Cohort-2 (2005–2007) and Cohort-3 (2011–2013).Participants3254 patients with NSTEACS who underwent first coronary revascularisation.Primary and secondary outcome measuresThe primary outcome was all-cause death. The secondary outcomes were cardiovascular death, cardiac death, sudden cardiac death, non-cardiovascular death, non-cardiac death, myocardial infarction, definite stent thrombosis, stroke, hospitalisation for heart failure, major bleeding, any coronary revascularisation and target vessel revascularisation.ResultsPatients in Cohort-3 were older and more often had heart failure at admission than those in Cohort-2. The prevalence of PCI, emergency procedure and guideline-directed medical therapy was higher in Cohort-3 than in Cohort-2. In patients who received PCI, the prevalence of transradial approach, drug-eluting stent use and intravascular ultrasound use was higher in Cohort-3 than in Cohort-2. There was no change in 3-year adjusted mortality risk from Cohort-2 to Cohort-3 (HR 1.00, 95% CI 0.83 to 1.22, p=0.97). Patients in Cohort-3 compared with those in Cohort-2 were associated with lower adjusted risks for stroke (HR 0.65, 95% CI 0.46 to 0.92, p=0.02) and any coronary revascularisation (HR 0.76, 95%CI 0.66 to 0.87, p<0.001), but with higher risk for major bleeding (HR 1.25, 95% CI 1.06 to 1.47, p=0.008). The unadjusted risk for definite stent thrombosis was lower in Cohort-3 than in Cohort 2 (HR 0.29, 95% CI 0.11 to 0.67, p=0.003).ConclusionsIn the past two decades, we did not find improvement for mortality in patients with NSTEACS. We observed a reduction in the risks for definite stent thrombosis, stroke and any coronary revascularisation, but an increase in the risk for major bleeding.

scholarly journals Kounis syndrome – an unusual etiology of acute myocardial infarction

2015 ◽  
Vol 10 (3) ◽  
pp. 295-299
Author(s):  
Vlad BĂTĂILĂ ◽  
◽  
Aura VÎJÎIAC ◽  
Lucian CÂLMÂC ◽  
Maria DOROBANŢU ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Conservative Approach ◽  
Inferior Myocardial Infarction ◽  
Kounis Syndrome ◽  
Wasp Sting ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Vasoactive Mediators ◽  
St Segment

Kounis syndrome is defined as an association between an acute coronary syndrome and acute systemic allergy involving vasoactive mediators released during the activation of the mast cells. A 79 year old woman arrives at the emergency department with syncope; she was stung by a wasp an hour before symptoms’ onset. Clinical examination was normal, excepet her left upper limb which had important edema. The ECG revealed ST-segment elevation in the inferior leads and negative T waves in the anterior leads. Emergency coronary angiography was performed, which revealed a 40% stenotic plaque on the mid LAD. A conservative approach was decided. The patient received standard anti-ischemic treatment and she was safely discharged after 6 days. We considered this case a Kounis syndrome induced by a wasp sting associated with a silent inferior myocardial infarction.

scholarly journals Markers of Poor Prognosis in Non-ST Segment Elevation Acute Coronary Syndromes Without Revascularization: A 3-Year Survival Analysis

2018 ◽  
Vol 2 (2) ◽  
pp. e000139
Author(s):  
Alexander Parkhomenko ◽  
Natalia Dovgan ◽  
Yaroslav Lutay ◽  
Sergey Kozhukhov
Keyword(s):  
Myocardial Infarction ◽  
Interventricular Septum ◽  
Cardiovascular Death ◽  
Silent Myocardial Ischemia ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Number Of Patients ◽  
History Of

Introduction: The non-ST elevation acute coronary syndrome (NSTE-ACS) account for more than 50% of the total number of patients with ACS. The mortality rates after NSTEMI are not significantly different when compared with patients with ST-segment elevation myocardial infarction. Aim: The aim of the present study was to investigate whether the assessment of clinical, laboratory and instrumental data during hospital stay provide any additional independent information in predicting the 3-year major cardiac events after NSTE-ACS. Methods: We observed 490 consecutive patients, who were admitted to the emergency cardiology department with NSTE-ACS. The patients' baseline characteristics, blood analysis, left ventricle (LV) and renal function data were assessed and analyzed. The median follow‑up time was 36 months. The endpoint was cardiovascular death. Results: The results of our study show that the risk of cardiovascular death during the three years follow-up after multivariate adjustment increases with older age (> 64 years), history of diabetes, prior myocardial infarction and history of angina pectoris, lower ejection fraction (<50%), degree of myocardial hypertrophy (the thickness of the interventricular septum >1.25 mm) of the LV and the degree of diastolic dysfunction (E-wave deceleration time (DT) < 150 ms), silent myocardial ischemia during first 24-hours, high pulse pressure on Day 1 (>49 mm Hg), glucose level > 7.5 mmol/l on admission and moderate kidney dysfunction (CrCl <60 ml/min). Conclusion: In patients with NSTE-ACS, we report the cardiovascular death risk factors within the 3-year follow-up period in the present study. We thus conclude that it is important to identify the patients with high risk of future cardiovascular complications.

Vorapaxar expands antiplatelet options

2012 ◽  
Vol 32 (03) ◽  
pp. 221-227 ◽  
Author(s):  
C. Bode ◽  
D. Duerschmied
Keyword(s):  
Myocardial Infarction ◽  
Antiplatelet Therapy ◽  
Arterial Disease ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Triple Antiplatelet Therapy ◽  
History Of ◽  
Peripheral Arterial ◽  
Ischemic Events

SummaryVorapaxar is the first substance of a new class of antiplatelet drugs that has been tested in large clinical trials. The protease-activated receptor 1 (PAR-1) antagonist inhibits thrombin-induced platelet activation to prevent atherothrombosis. In the phase 3 trials TRACER (acute coronary syndrome) and TRA 2P-TIMI 50 (stable atherosclerosis) reducing ischemic events with vorapaxar came at the cost of bleeding.TRACER compared vorapaxar to placebo in 12 944 patients who had non-ST-segment elevation acute coronary syndromes on top of contemporary treatment including dual antiplatelet therapy (aspirin and clopidogrel). Vorapaxar reduced ischemic events non-significantly, but increased bleeding significantly, therefore not justifying triple antiplatelet therapy in this setting. Follow-up was stopped early because of bleeding. TRA 2P-TIMI 50 examined 26 449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease. Vorapaxar reduced ischemic events and increased bleeding both significantly. Recruitment of patients with prior stroke was stopped early. Net clinical outcome and subgroup analyses suggested that vorapaxar could be beneficial for patients with prior myocardial infarction – but no history of stroke.

scholarly journals The predictive value of soluble osteoclast-associated receptor for the prognosis of acute coronary syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rong Wang ◽  
Jing Wang ◽  
Ling Xie ◽  
Hong-li Cai ◽  
Yi Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Predictive Value ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
History Of

AbstractAt present, prognostic biomarkers of acute coronary syndrome (ACS) are fewer. The aim of this study was to explore the predictive value of soluble osteoclast-associated receptor (sOSCAR) level for the major adverse cardiovascular events (MACE) occurring within 30 days after ACS. From January to August 2020, a total of 108 patients with ACS who were admitted to our hospital, were enrolled in this study. Of the 108 patients, 79 were men and 29 women. Patient-related data, including age, sex, body mass index, history of type 2 diabetes, history of hyperlipidemia and serum sOSCAR level, were collected. All patients were followed up for 30 days. Based on MACE occurrence, the 108 patients were divided into MACE group (n = 17) and non-MACE group (n = 91). The baseline data were compared between the two groups, MACE-independent risk factors were identified by multivariate regression analysis, and the predictive value of sOSCAR for MACE occurring within 30 days after CAS was analyzed using receiver operating characteristic (ROC) curve. At the same time, according to the type of ACS, the 108 patients with ACS were divided into unstable angina (UA) group (n = 29), non ST-segment elevation myocardial infarction (USTEMI) group (n = 45) and ST-segment elevation myocardial infarction (STEMI) group (n = 34), and then the sOSCAR level and MACE incidence were observed in each group. The serum sOSCAR level was significantly lower in the MACE group [130(100,183)] than in the non-MACE group [301(220,370)] (P = 0.000). The area under ROC curve of sOSCAR level for MACE occurring within 30 days after CAS was 0.860 with 95%CI 0.782–0.919, P < 0.001. Multivariate regression analysis indicated that the sOSCAR level was an independent risk factor for the MACE occurring within 30 days after CAS (OR 0.26, 95%CI 0.087–0.777, P = 0.04). The MACE incidence (0%) was the lowest but the sOSCAR level was the highest in the UA group, while in the STEMI group, the MACE incidence (23.53%) was the higest but the sOSCAR level was the lowest among the UA, STEMI and NSTEMI groups. Serum sOSCAR level may be used as a predictor of MACE occurring within the short-term after ACS. The higher the sOSCAR level, the lower the MACE incidence.

scholarly journals Ticagrelor Versus Clopidogrel in ST Segment Elevation Myocardial Infarction Patients Candidate for Primary Percutaneous Coronary Intervention

2021 ◽  
pp. 263246362110048
Author(s):  
Hassan Mohamed Ebeid ◽  
Hossameldin Abdelkhalek Rasmy Mohamed ◽  
Khaled Ahmed Elkhashab ◽  
Mohamed Abdulaziz Aljarallah ◽  
Mai Magedi Abdo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Coronary Intervention ◽  
Platelet Inhibitors ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
History Of ◽  
Definite Stent Thrombosis

Objective: To evaluate the incidence rate of definite stent thrombosis and major adverse cardiovascular events (MACE) with Ticagrelor versus Clopidogrel in ST segment elevation myocardial infarction (STEMI) patients candidate for primary percutaneous coronary intervention (PCI). Methods: STEMI participants naïve to antiplatelets, with no history of coronary artery disease (CAD) and candidate for primary PCI were included, while participants with history of CAD were excluded. Two hundred consecutive participants were selected, divided into 2 groups of 100 participants each, received either Ticagrelor or Clopidogrel, and followed up at 3 and 6 months. Results: The percent of patients in the Ticagrelor group who developed definite stent thrombosis (in-hospital and total) was 0%, while the percent of patients in the Clopidogrel group who developed definite stent thrombosis (in-hospital and total) was 8% and 9%, respectively. There were statistically significant weak associations between the class of P2Y12 platelet inhibitors and definite stent thrombosis (in-hospital and total) (X2 = 8.33, P = .004, V = 0.204 and Χ2 = 9.424, P = .002, V = 0.217, respectively). The percent of patients in the Ticagrelor and Clopidogrel groups who developed in-hospital MACE was 1% and 9%, respectively. There was a statistically weak significant association between the class of P2Y12 platelet inhibitors and in-hospital MACE (X2 = 6.74, P = .009, V = 0.184). Conclusion: Ticagrelor is more efficacious than Clopidogrel in preventing definite stent thrombosis (in-hospital and total) and in-hospital MACE in STEMI patients.

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