Nilotinib related acute myocardial infarction with nonobstructive coronary arteries: a case report and literature review

BMC Cardiovascular Disorders

Kun Liu¹  Weiwei Chen¹  Beibei Du¹  Ping Yang¹  Zhixi Yu¹  Xingtong Wang² 

[1] Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai, Street No. 126, 130033, Changchun, Jilin Province, China;Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, 130031, Changchun, Jilin Province, China;Department of Hematology, The First Hospital of Jilin University, Jilin Provincial Hematology Research Institute, National Key Discipline in Hematology and Oncology, 130021, Changchun, Jilin Province, China;

关键词: Myocardial Ischemia with No Obstructive Coronary Artery Disease;    Coronary artery spasm;    Nilotinib;    Ergonovine provocation test;    Vascular adverse events;    Case report;   

DOI  :  10.1186/s12872-022-02504-0

来源: Springer

【 摘 要 】

BackgroundMyocardial Ischemia with No Obstructive Coronary Artery Disease (MINOCA) is a common cause of type 2 acute myocardial infarction (AMI) which requires careful differential diagnosis. Coronary artery spasm (CAS) syndrome is one etiology that can lead to MINOCA. Nilotinib, a targeted treatment for chronic myeloid leukemia (CML), has been reported to be related with increased risk of adverse vascular events.Case presentationA 67-year-old male patient was admitted to hospital with acute chest pain. He had a past medical history of CML and a history of treatment with nilotinib for 12 months. Coronary angiography (CAG) showed no significant stenosis. Since the onset of angina was generally in the early morning, and ECG and echocardiography suggested right coronary artery (RCA) disease, an ergonovine provocation test was performed to confirm the diagnosis of CAS. After intracoronary administration of ergonovine, middle and distal RCA showed over 90% vasoconstriction. Nilotinib related MINOCA, CAS and CML were diagnosed. Lifestyle changes (cessation of smoking), anti-spasmodics, statin treatment and adjustment of the nilotinib dose (from 200 mg bid, to 150 mg bid) were recommended for this patient. Six-month’s follow-up showed good recovery with no onsets of angina.ConclusionsPhysicians should be vigilant to adverse vascular events when treating patients who have been prescribed nilotinib. It is suggested that in patients with MINOCA who have a history of treatment with nilotinib, CAS-induced MINOCA should be included in the differential diagnosis. Further studies are needed to clarify the mechanism and to find better management.

【 授权许可】

CC BY