Advanced Coronary Atherosclerosis and Fatal Myocardial Infarction in Mild Dyslipidemic, Low Risk Young Man: A Case Report With Literature Reviewed
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Published:
Feb 20, 2019
Keywords:
sudden death, young myocardial infarction, premature atherosclerosis, mild hypercholesterolemia, myocardial bridging, epicardial adipose tissue, COX 2 inhibitor
Main Article Content
Abstract
Acute Myocardial infarction (AMI) at a young age (below 45 years) is rare and difficult to predict. We reported a fatal myocardial infarction from advanced atherosclerosis in a healthy young man who had no other major coronary risk factors except mild hypercholesterolemia. Thus, all available systemic risk scores identified him as a low risk candidate for developing a cardiovascular event. Autopsy revealed advanced atherosclerosis in all three major coronary arteries causing acute and old myocardial infarction. Thick epicardial adipose tissue and myocardial bridging of the mid left anterior descending artery were also noted. He frequently used etoricoxib to treat knee and back pain for consecutive five years. Potential mechanisms of sudden death from atherosclerosis, myo- cardial bridging, epicardial adipose tissue and selective COXIB are discussed in more detail below.
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How to Cite
1.
Veerakul G, Ruttapichairuk N, Ruangmondhop V. Advanced Coronary Atherosclerosis and Fatal Myocardial Infarction in Mild Dyslipidemic, Low Risk Young Man: A Case Report With Literature Reviewed. BKK Med J [Internet]. 2019 Feb. 20 [cited 2024 Apr. 25];15(1):66. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/222699
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Case Report
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References
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5. Chen TS, Incani A, Butler TC, et al. The demographic profileof young patients (
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10. FitzGerald GA. COX-2 and beyond: approaches toprostaglandin inhibition in human disease. Nat Rev DrugDiscov 2003;2:879-90.
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12. Nissen SE, Yeomans ND, Solomon DH, et al. Cardiovascularsafety of celecoxib, naproxen, or ibuprofen for arthritis. NEngl J Med 2016; 375(26):2519-29.
13. De Vecchis R, Bald C, Di Biase G, et al. Cardiovascular riskassociated with celecoxib or etoricoxib: a meta-analysis ofrandomized controlled trials which adopted comparison withplacebo or naproxen. Minerva Cardioangiol 2014; 62:437-48.
14. Trelle S, Reichenbach S, Wandel S, et al. Cardiovascularsafety of non-steroidal anti-inflammatory drugs: networkmeta-analysis. BMJ 2011;342:c7086 doi:10.1136/bmj.c7086
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16. Lenzer J. FDA advisers warn: COX 2 inhibitors increase riskof heart attack and stroke. BMJ 2005; 330(26):440.
17. Antman EM, DeMets D, Loscalzo J. Cyclooxygenase Inhibitionand Cardiovascular Risk, special report. Circulation2005;112:759-70.
18. Noble J, Bourassa MG, Petitclerc R, et al. Myocardial bridgingand milking effect of the left anterior descending coronaryartery: normal variant or obstruction? Am J Cardiol1976;37:993-9.
19. Kramer JR, Kitazume H, Proudfit WL, et al. Clinical significanceof isolated coronary bridges: benign and frequent conditioninvolving the left anterior descending artery. Am Heart J1982;103:283-88.
20. Leschka S, Koepfli P, Husmann L, et al. Myocardial bridging:Depiction rate and morphology at CT coronary angiography:Comparison with conventional coronary angiography. Radiology2008;246:754-62.
21. Lee SS, Wu TL. The role of the mural coronary artery inprevention of coronary atherosclerosis. Arch Pathol1972;93:32-5.
22. Kramer JR, Kitazume H, Proudfit WL, et al. Clinicalsignificance of isolated coronary bridges: benign and frequentcondition involving the left anterior descending artery. AmHeart J 1982;103:283-88.
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25. Bergmark BA, Galper BZ, Shah AM, et al. Myocardial bridgingin a man with non–ST-elevation myocardial infarction.Circulation 2015 131(11):e373-e374
26. Arjomand H, AlSalman J, Azain J, et al. Myocardial bridgingof left circumflex coronary artery associated with acutemyocardial infarction. J Invasive Cardiol 2000;12(8):431-4.
27. Tio RA, Ebels T. Ventricular septal rupture caused bymyocardial bridging. Ann Thoracic Surg 2001;72:1369-70.
28. Den Dulk K, Brugada P, Braat S, et al. Myocardial bridgingas a cause of paroxysmal atrioventricular block. J Am CollCardiol 1983;1: 965–9.
29. Feld H, Guadanino V, Hollander G, et al. Exercise-inducedventricular tachycardia in association with a myocardialbridge. Chest 1991;99:1295-6.
30. MCutler D, Wallace JM. Myocardial bridging in a youngpatient with sudden death. Clin Cardiol 1997;20:581-3.
31. Hostiuc S, Rusu MC, Hostiu M, et al. Cardiovascularconsequences of myocardial bridging: A meta- analysis andmeta-regression. Sci Rep 2017;7:14644. DOI:10.1038/s41598-017-13958-0.
32. Ishikawa Y, Kawawa Y, Kohda E, et al. Significance of theanatomical properties of a myocardial bridge in coronary heartdisease. Circ J 2011;75:1559-66.
33. Bourassa MG, Butnaru A, Lesperance J, et al. Symptomaticmyocardial bridges: overview of ischemic mechanisms andcurrent diagnostic and treatment strategies. J Am CollCardiol 2003;41:351–9.
34. Klues HG, Schwarz ER, vom Dahl J, et al. Disturbedintracoronary hemodynamics in myocardial bridging: earlynormalization by intracoronary stent placement. Circulation1997; 96:2905-13.
35. Risse M, Weiler G. Coronary muscle bridge and its relationsto local coronary sclerosis, regional myocardial ischemia andcoronary spasm: a morphometric study [German]. Z Kardiol1985;74:700–5.
36. Masuda T, Ishikawa Y, Akasaka Y, et al. The effect ofmyocardial bridging of the coronary artery on vasoactive agentsand atherosclerosis localization. J Pathol 2001;193: 408-14.
37. Ishii T, Asuwa N, Masuda S, et al. Atherosclerosis suppressionin the left anterior descending coronary artery by the presenceof a myocardial bridge: an ultrastructural study. Mod Pathol1991;4:424-31.
38. Teragawa H, Fukuda Y, Matsuda K, et al. Myocardial BridgingIncreases the risk of Coronary Spasm. Clin Cardiol2003;26:377-83.
39. Piepoli MF, Hoes AW, Agewall S, et al. 2016 EuropeanGuidelines on cardiovascular disease prevention in clinicalpractice: The Sixth Joint Task Force of the European Societyof Cardiology and Other Societies on Cardiovascular DiseasePrevention in Clinical Practice (constituted by representativesof 10 societies and by invited experts). Eur Heart J 2016;37(29):2315-81.
40. Shapiro M, Fazio S. Familial hypercholesterolemia: use ofregistries, biobanks, and cohort studies to improve itsdiagnosis and management in non-western populations. BKKMed J 2018; 14(1):63-8.
41. Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: areport of the American College of Cardiology/American HeartAssociation Task Force on Practice Guidelines. Circulation2014;129(25suppl2):S49-73.
42. Sritara P, Cheepudomwit S, Chapman N, et al. Twelve yearchanges in vascular risk factors and their associations withmortality in a cohort of 3,499 Thais: the electricity generatingauthority of Thailand study. Int J Epidemiol 2003;32:461-8.
43. World Health Organization. Prevention of cardiovasculardisease: pocket guidelines of assessment and management ofcardiovascular risk (WHO/ISH Cardiovascular Risk PredictionCharts for WHO epidemiological sub-regions AFR D andAFR E), Geneva 2007, (Accessed at January 15, 2019 athttps://www.who.int/cardiovascular_diseases/guidelines/PocketGL.ENGLISH.AFR-D-E.rev1.pdf?ua=1).
44. Veerakul G, Khajornyai A, Wongkasia S, et al. Predicting andpreventing cardiovascular events in asymptomatic patients: a10-year prospective study. BKK Med J 2017;13:1-12.
45. Knot UN, Khot MB, Bajzer CT, et al. Prevalence ofconventional risk factors in patients with coronary heartdisease. JAMA 2003;290(7);898-904.
46. Zhong Z, Liu J, Li B et al. Serum lipid profiles in patientswith acute myocardial infarction in Hakka population insouthern China. Lipids Health Dis 2017;16(1):246. doi:10.1186/s12944-017-0636-x.
47. Mazurek T, Zhnag L, Zalewski A, et al. Human epicardialadipose tissue is a source of inflammatory mediators. Circulation2003;108:2460-6.
48. Meenakshi K, rajendran M, Srikumar S, et al. Epicardial fatthickness: A surrogate marker of coronary artery disease,assessment by echocardiography. Indian Heart J 2006;68:336-41.
49. Hwang IC, Park HE, Choi SY. Epicardial adipose tissuecontributes to the development of non-calcified coronaryplaque: a 5-year computed tomography follow-up study. JAtheroscler Thromb 2017;24:262-74. doi:10.5551/jat.36467.
50. Kaikita K. Epicardial adipose tissue as a predictor for thedevelopment of Non-calcified coronary plaque. J AtherosclerThromb 2017;24:254-5. doi: 10.5551/jat.ED062.
2. Guipeng A, Zhongqi Du, Xiao M, et al. Risk factors for long-termoutcome of drug-eluting stenting in adults with early-onsetcoronary artery disease. Inter J Medical Sciences2014;11(7):721-5.doi: 10.7150/ijms.8718
3. Tungsubutra W, Treesukosol D, Buddhari W, et al. Acutecoronary syndrome in young adults: the Thai ACS Registry.J Med Assoc Thai 2007; 90(Suppl1):81-90.
4. Wong CP, Loh SY, Loh KK, et al. Acute myocardial infarction:Clinical features and outcomes in young adults in Singapore.World Cardiol J 2012; 496:206-10.
5. Chen TS, Incani A, Butler TC, et al. The demographic profileof young patients (
6. Narongchai P, Narongchai S. Study of the normal internalorgan weights in Thai population. J Med Assoc Thai2008;91(5):747-53.
7. Egred M, Viswannathan G, Davis K. Myocardial infarctionin young adults. Postgrad Med J 2005;81:741-5. doi: 10.1136/pgmj.2004.027532
8. Hill SF, Sheppard MN. Non-atherosclerotic coronary arterydisease associated with sudden cardiac death. Heart 2010;96:1119-25.
9. Gorenek B, Lundqvist CB, Terradellas JB, et al. Cardiacarrhythmias in acute coronary syndromes: The joint task forceEHRA, ACCA, and EAPCI task force. EuroIntervention2015;10(9):1095-108. doi: 10.4244/EIJY14M08_19
10. FitzGerald GA. COX-2 and beyond: approaches toprostaglandin inhibition in human disease. Nat Rev DrugDiscov 2003;2:879-90.
11. FitzGerald GA. Coxibs and cardiovascular disease. N Engl JMed 2014;351(17):209-11.
12. Nissen SE, Yeomans ND, Solomon DH, et al. Cardiovascularsafety of celecoxib, naproxen, or ibuprofen for arthritis. NEngl J Med 2016; 375(26):2519-29.
13. De Vecchis R, Bald C, Di Biase G, et al. Cardiovascular riskassociated with celecoxib or etoricoxib: a meta-analysis ofrandomized controlled trials which adopted comparison withplacebo or naproxen. Minerva Cardioangiol 2014; 62:437-48.
14. Trelle S, Reichenbach S, Wandel S, et al. Cardiovascularsafety of non-steroidal anti-inflammatory drugs: networkmeta-analysis. BMJ 2011;342:c7086 doi:10.1136/bmj.c7086
15. Veerakul G, Lapanun W, Sindhuwanna U, et al. Acutemyocardial infarction development after COX-2 inhibitor drugadministration: a report of two cases. Intern Med J Thai 2005;21(4):276-81.
16. Lenzer J. FDA advisers warn: COX 2 inhibitors increase riskof heart attack and stroke. BMJ 2005; 330(26):440.
17. Antman EM, DeMets D, Loscalzo J. Cyclooxygenase Inhibitionand Cardiovascular Risk, special report. Circulation2005;112:759-70.
18. Noble J, Bourassa MG, Petitclerc R, et al. Myocardial bridgingand milking effect of the left anterior descending coronaryartery: normal variant or obstruction? Am J Cardiol1976;37:993-9.
19. Kramer JR, Kitazume H, Proudfit WL, et al. Clinical significanceof isolated coronary bridges: benign and frequent conditioninvolving the left anterior descending artery. Am Heart J1982;103:283-88.
20. Leschka S, Koepfli P, Husmann L, et al. Myocardial bridging:Depiction rate and morphology at CT coronary angiography:Comparison with conventional coronary angiography. Radiology2008;246:754-62.
21. Lee SS, Wu TL. The role of the mural coronary artery inprevention of coronary atherosclerosis. Arch Pathol1972;93:32-5.
22. Kramer JR, Kitazume H, Proudfit WL, et al. Clinicalsignificance of isolated coronary bridges: benign and frequentcondition involving the left anterior descending artery. AmHeart J 1982;103:283-88.
23. Juillière Y, Berder V, Suty-Selton C, et al. Isolated myocardialbridges with angiographic milking of left anterior descendingcoronary artery: a long-term follow-up study. Am Heart J1995; 129:663-5.
24. Bauters C, Chmait A, Tricot O, et al. Coronary thrombosisand myocardial bridging. Circulation 2002;105(1):130.
25. Bergmark BA, Galper BZ, Shah AM, et al. Myocardial bridgingin a man with non–ST-elevation myocardial infarction.Circulation 2015 131(11):e373-e374
26. Arjomand H, AlSalman J, Azain J, et al. Myocardial bridgingof left circumflex coronary artery associated with acutemyocardial infarction. J Invasive Cardiol 2000;12(8):431-4.
27. Tio RA, Ebels T. Ventricular septal rupture caused bymyocardial bridging. Ann Thoracic Surg 2001;72:1369-70.
28. Den Dulk K, Brugada P, Braat S, et al. Myocardial bridgingas a cause of paroxysmal atrioventricular block. J Am CollCardiol 1983;1: 965–9.
29. Feld H, Guadanino V, Hollander G, et al. Exercise-inducedventricular tachycardia in association with a myocardialbridge. Chest 1991;99:1295-6.
30. MCutler D, Wallace JM. Myocardial bridging in a youngpatient with sudden death. Clin Cardiol 1997;20:581-3.
31. Hostiuc S, Rusu MC, Hostiu M, et al. Cardiovascularconsequences of myocardial bridging: A meta- analysis andmeta-regression. Sci Rep 2017;7:14644. DOI:10.1038/s41598-017-13958-0.
32. Ishikawa Y, Kawawa Y, Kohda E, et al. Significance of theanatomical properties of a myocardial bridge in coronary heartdisease. Circ J 2011;75:1559-66.
33. Bourassa MG, Butnaru A, Lesperance J, et al. Symptomaticmyocardial bridges: overview of ischemic mechanisms andcurrent diagnostic and treatment strategies. J Am CollCardiol 2003;41:351–9.
34. Klues HG, Schwarz ER, vom Dahl J, et al. Disturbedintracoronary hemodynamics in myocardial bridging: earlynormalization by intracoronary stent placement. Circulation1997; 96:2905-13.
35. Risse M, Weiler G. Coronary muscle bridge and its relationsto local coronary sclerosis, regional myocardial ischemia andcoronary spasm: a morphometric study [German]. Z Kardiol1985;74:700–5.
36. Masuda T, Ishikawa Y, Akasaka Y, et al. The effect ofmyocardial bridging of the coronary artery on vasoactive agentsand atherosclerosis localization. J Pathol 2001;193: 408-14.
37. Ishii T, Asuwa N, Masuda S, et al. Atherosclerosis suppressionin the left anterior descending coronary artery by the presenceof a myocardial bridge: an ultrastructural study. Mod Pathol1991;4:424-31.
38. Teragawa H, Fukuda Y, Matsuda K, et al. Myocardial BridgingIncreases the risk of Coronary Spasm. Clin Cardiol2003;26:377-83.
39. Piepoli MF, Hoes AW, Agewall S, et al. 2016 EuropeanGuidelines on cardiovascular disease prevention in clinicalpractice: The Sixth Joint Task Force of the European Societyof Cardiology and Other Societies on Cardiovascular DiseasePrevention in Clinical Practice (constituted by representativesof 10 societies and by invited experts). Eur Heart J 2016;37(29):2315-81.
40. Shapiro M, Fazio S. Familial hypercholesterolemia: use ofregistries, biobanks, and cohort studies to improve itsdiagnosis and management in non-western populations. BKKMed J 2018; 14(1):63-8.
41. Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: areport of the American College of Cardiology/American HeartAssociation Task Force on Practice Guidelines. Circulation2014;129(25suppl2):S49-73.
42. Sritara P, Cheepudomwit S, Chapman N, et al. Twelve yearchanges in vascular risk factors and their associations withmortality in a cohort of 3,499 Thais: the electricity generatingauthority of Thailand study. Int J Epidemiol 2003;32:461-8.
43. World Health Organization. Prevention of cardiovasculardisease: pocket guidelines of assessment and management ofcardiovascular risk (WHO/ISH Cardiovascular Risk PredictionCharts for WHO epidemiological sub-regions AFR D andAFR E), Geneva 2007, (Accessed at January 15, 2019 athttps://www.who.int/cardiovascular_diseases/guidelines/PocketGL.ENGLISH.AFR-D-E.rev1.pdf?ua=1).
44. Veerakul G, Khajornyai A, Wongkasia S, et al. Predicting andpreventing cardiovascular events in asymptomatic patients: a10-year prospective study. BKK Med J 2017;13:1-12.
45. Knot UN, Khot MB, Bajzer CT, et al. Prevalence ofconventional risk factors in patients with coronary heartdisease. JAMA 2003;290(7);898-904.
46. Zhong Z, Liu J, Li B et al. Serum lipid profiles in patientswith acute myocardial infarction in Hakka population insouthern China. Lipids Health Dis 2017;16(1):246. doi:10.1186/s12944-017-0636-x.
47. Mazurek T, Zhnag L, Zalewski A, et al. Human epicardialadipose tissue is a source of inflammatory mediators. Circulation2003;108:2460-6.
48. Meenakshi K, rajendran M, Srikumar S, et al. Epicardial fatthickness: A surrogate marker of coronary artery disease,assessment by echocardiography. Indian Heart J 2006;68:336-41.
49. Hwang IC, Park HE, Choi SY. Epicardial adipose tissuecontributes to the development of non-calcified coronaryplaque: a 5-year computed tomography follow-up study. JAtheroscler Thromb 2017;24:262-74. doi:10.5551/jat.36467.
50. Kaikita K. Epicardial adipose tissue as a predictor for thedevelopment of Non-calcified coronary plaque. J AtherosclerThromb 2017;24:254-5. doi: 10.5551/jat.ED062.