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Review
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Korean J Med. 2006;71(1):293-293.
- Multivessel AMI in patient with decreased protein S activity
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- Multivessel AMI in patient with decreased protein S activity
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1Department of Internal Medicine, Hanyang University College of Medicine, Seoul; 2Department of Life Science, Postech Biotech Center, Pohang University of Science and Technology, Pohang, Korea
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- Abstract
- Background : Protein S is one of the most important antithrombotic components. The main triggering events of AMI is the
rupture or fissuring of coronary atheroma, followed by the total or subtotal occlusion of coronary artery induced by the thrombus
formation. Meanwhile, turnover of thrombus depends not only on its formation but also on its lysis. We experienced a rare case
of multivessel AMI in patient with decreased protein S activity. Case: A 51-year-old male was admitted to our hospital with
acute myocardial infarction. The ECG revealed ST segment elevation in V2-6, and the cardiac markers were elevated.
Echocardiography showed akinesia of the apex, septum, anterior wall and the left ventricular systolic function was decreased
(LVEF 35%). Left coronary angiography revealed near total occlusion with a visible thrombus in the mid left anterior descending
(LAD) and total occlusion in the obtuse marginal (OM) branch of left circumflex coronary artery(figure 1). We tried to remove
the thrombus by using an export catheter but could not. We injected the glycoprotein IIb/IIIa inhibitor (Tirofiban) and balloon
angioplasty was done. The final angiography showed improved TIMI III flow at the mid LAD and TIMI I flow at the OM.
Follow up angiography after 7 days revealed no occlusion in the left coronary artery and flow was improved with TIMI III(figure
2). Laboratory testing for hypercoagulability was abnormal (Protein S activity 54%). After that anticoagulation therapy with
warfarin was continued and the patent experienced no chest pain during this period.
Keywords :
