Difficult management of coronary artery disease in a patient with thrombotic thrombocytopenic purpura

Thrombotic thrombocytopenic purpura [TTP] is a rare syndrome affecting multiple organs. There is no sufficient evidence regarding the clinical cardiac manifestations of TTP. Nonetheless, pathologic cardiac involvement is quite frequent in acute TTP, which is predominantly manifested as myocardial necrosis due to coronary arteriolar microthrombosis. The present case report describes a 43-year-old man with long-standing remitted TTP, who suffered from a sequence of refractory thrombotic epicardial coronary events. Aggressive medical and interventional therapies, including long-term dual antiplatelets and coronary angioplasty, were finally successful in remitting the thrombotic events. During his two-year follow up, he has been asymptomatic

Intracoronary adenosine to prevent myonecrosis in patients with stable angina undergoing percutaneous interventions: a double-blinded randomized controlled trial

Significant elevation of cardiac biomarkers after percutaneous coronary intervention [PCI] is associated with increased mortality. However, clinical importance of lesser degrees of cardiac enzyme elevation has not been well understood. Multiple factors might have an etiologic role, and the incidence of myonecrosis has not changed dramatically despite pharmacological and technological advances in PCI. The aim of this study was to evaluate the role of intracoronary [1C] Adenosine in preventing the elevation of cardiac enzymes as a marker of myonecrosis after PCI in patients with chronic stable angina. Two hundred sixty patients with chronic stable angina who were candidates for PCI were randomly assigned to double-blinded pretreatment with 1C Adenosine or placebo before crossing of the guide wire. The patients were observed during the hospital course, and blood samples were obtained in standard intervals after the intervention for cardiac biomarkers. The primary end point of this study was post-PCI myonecrosis, and secondary end point was safety of 1C Adenosine administration in the setting of PCI in patients with chronic stable angina. Of the 260 patients, who were initially randomized, finally 83 patients were analyzed in the placebo and 96 in the Adenosine arms. The study patients were comparable in clinical and angio graphic characteristics. The mean of the patients age was 57.3 years [range = 35 to 79 years], and 77.5% were male. There were no differences in the mean serum cardiac biomarkers between the study groups [mean creatine kinase-MB [CK.MB] level of 29.5 +/- 14.5 IU/L in the placebo group and 31.5 +/- 18.5 IU/L in the control group; p value = 0.41; mean cardiac troponin I [cTnI] level of 0. 097 _0.178 microg/L in the placebo group and 0.167 +/- 0.5 microg/L in the control group; p value = 0.24]. Despite promising results in primary PCI, our study showed that a strategy of 1C Adenosine pretreatment is not beneficial in reducing post-PCI myonecrosis in patients with chronic stable angina and should not be routinely used