Wang ZM, Chen WH, Wu YM, Wang LQ, Ye FL, Yin RL. Essential thrombocythemia with non-ST-segment elevation myocardial infarction as the first manifestation: A case report. World J Clin Cases 2022; 10(21): 7422-7428 [PMID: 36158029 DOI: 10.12998/wjcc.v10.i21.7422]
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Zhi-Ming Wang, Wei-Hai Chen, Yan-Ming Wu, Lin-Quan Wang, Fu-Long Ye, Ren-Lin Yin, Department of Cardiology, Suzhou Ninth People's Hospital, Soochow University, Suzhou 215200, Jiangsu Province, China
Author contributions: Wang ZM and Yin RL contributed to the conceptualization of the study; Wang LQ and Ye FL contributed to the methodology; Chen WH and Wu YM contributed to the formal analysis and data curation; Wang ZM contributed to the writing-original draft preparation; Yin RL provided supervision; all authors have read and agreed to the published version of the manuscript.
Informed consent statement: Study participant provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: September 29, 2021 Peer-review started: September 29, 2021 First decision: November 11, 2021 Revised: November 24, 2021 Accepted: June 16, 2022 Article in press: June 16, 2022 Published online: July 26, 2022 Processing time: 284 Days and 18.8 Hours
Abstract
BACKGROUND
We report a case of essential thrombocythemia (ET) in a 44-year-old male who exhibited non-ST-segment-elevation myocardial infarction (NSTEMI) as the first manifestation without known cardiovascular risk factors (CVRFs). For the first time, we reported a left main trifurcation lesion in NSTEMI caused by ET, including continuous stenosis lesions from the left main to the ostial left anterior descending (LAD) artery and an obvious thrombotic lesion in the ostial and proximal left circumflex (LCX) artery. There was 60% diffuse stenosis in the left main (LM) that extended to the ostial LAD, thrombosis of the ostial LAD and proximal LCX, and 90% stenosis in the proximal LCX. During the operation, thrombus aspiration was performed, but no obvious thrombus was aspirated. Performing the kissing balloon technique (KBT) in the LCX and LM unexpectedly increased the narrowness of the LAD. Then, the single-stent crossover technique, final kissing balloon technique and proximal optimization technique (POT) were performed. On the second day after percutaneous coronary intervention (PCI), the number of platelets (PLTs) still increased significantly to as high as 696 × 109/L. The bone marrow biopsy done later, together with JAK2 (exon 14) V617F mutation, confirms the diagnosis of ET. Hydroxyurea was administered to inhibit bone marrow proliferation to control the number of PLTs.
CASE SUMMARY
A 44-year-old male patient went to a local hospital for treatment for intermittent chest pain occurring over 8 h. The examination at the local hospital revealed elevated cTnI and significantly elevated platelet. Then, he was diagnosed with acute myocardial infarction and transferred to our hospital for emergency interventional treatment by ambulance. During the operation, thrombus aspiration, the single-stent crossover technique, final kissing balloon technique and POT were performed. Dual antiplatelet therapy comprising aspirin and ticagrelor was used after PCI. Evidence of mutated JAK2 V617F and bone marrow biopsy shown the onset of ET. Together with JAK2 (exon 14) V617F mutation, ET was diagnosed according to the World Health Organization (WHO) diagnostic criteria, and the patient was placed on hydroxyurea. During the one-year postoperative period, repeated examinations showed a slight increase in PLTs, but the patient no longer had chest tightness, chest pain or bleeding or developed new thromboembolisms.
CONCLUSION
Routine physical examinations and screenings are conducive to the early detection of ET, and the risk for thrombosis should be assessed. Then, active antiplatelet therapy and myelosuppression therapy should be used for high-risk ET patients.
Core Tip: The emergency interventional treatment plan for acute myocardial infarction (AMI) caused by essential thrombocythemia is generally the same as that for AMI, and if conditions permit, intravenous ultrasound can provide imaging guidance for stent implantation. Taking aspirin to prevent the number of platelet (PLT) aggregation is very important, and conventional anticoagulation therapy is not recommended. For patients with significantly elevated PLT counts, achieving bone marrow suppression and control of PLT counts are also very important. The ideal target number of PLTs should be below 400 × 109/L.
