Five of these individuals were female and the mean age for these individuals was 41??8?years. (APLS) is well known to cause thrombotic events and premature atherosclerosis leading to coronary artery occlusion . The association of non-thrombotic acute myocardial infarctions (AMI) with APLS is not as clearly delineated. Our group offers previously reported individual instances of AMI with non-obstructive coronary arteries (MINOCA) with this populace. MINOCA has gained increasing acknowledgement in the medical literature and accounts for approximately 6% of AMI presentations . Based on our anecdotal encounter, we hypothesize that there is a greater prevalence of MINOCA in individuals with APLS. Potential underlying mechanisms of MINOCA include coronary spasm, coronary microvascular dysfunction, takotsubo cardiomyopathy, and myocardial disorders including myopericarditis . Paradoxically, thrombophilia claims are relatively common in those showing with MINOCA . The objective of this study was to determine the relative prevalence of MINOCA compared to MI from vaso-occlusive disease amongst individuals with known APLS at our institution. 2.?Methods Our institutional database was queried for those individuals screening positive for antiphospholipid antibodies (n?=?575) between 2000 Rabbit Polyclonal to Actin-pan and 2012. APLS syndrome was defined in individuals who met one or more medical or laboratory criteria. Clinical criteria include (a) vascular thrombosis (arterial, venous, or small-vessel thrombus in any organ) or (b) complication of pregnancy. Laboratory criteria includes (a) anticardiolipin antibodies positive on two or more occasions at least six weeks apart (b)lupus anticoagulant antibodies positive on two or more occasions at least six weeks apart . From this sample, we recognized 46 individuals having cardiac catheterization. Of these total individuals, six were excluded since they received cardiac catheterization for reasons other than ACS. ACS was defined based on ischemic symptoms with elevation of troponin (troponin em I /em ? ?0.1?mg/dL) with or without electrocardiographic (ECG) changes, per the common definition of MI . Cardiac angiography reports were analyzed for these 40 individuals. The analysis of MINOCA was made if the patient had (a) signs and symptoms of a 3-Hydroxyisovaleric acid myocardial infarction according to the common definition of AMI  (b) the exclusion of obstructive CAD (obstructive CAD is typically defined as 50% stenosis in the major vessels) and (c) no additional overt cause of the AMI . Table 3-Hydroxyisovaleric acid 1 shows the selection of individuals. Table 1 Characteristics of individuals showing with APLS and MINOCA. thead th rowspan=”1″ colspan=”1″ /th th rowspan=”1″ colspan=”1″ Nonthrombotic (n?=?8) /th /thead Age, mean (STD)41??8Female (%)5 (63)Race/ethnicity?White colored0?Black6 (75)?Hispanic2 (25)?Additional0Coronary risk factors?HTN8 (100)?HLD7 (88)?DM4 (50)?CKD3 (38)?CVA5 (63)?TIA1 (13)APLS Abdominal?aCL IgM3 (38)?aCL IgG3 (38)?aCL IgA1 (13)?abdominal2 GPI IgM0 (0)?abdominal2 GPI IgG2 (25)?aB2GPI IgA0 (0)?aLA5 (63)Peak troponin0.36 (IQR:0.17C0.53)Echo findings?Normal LVEF and wall motion6 (75)?Additional2 (25)INR (n?=?6)2.35 (IQR:1.9C2.65) Open in a separate window 2.1. Statistical analysis We analyzed the baseline characteristics in APLS individuals with non-obstructive CAD using descriptive statistical analysis techniques. The variability of continuous measures was displayed as means and standard deviations when they adopted a normal distribution and with medians and interquartile ranges when they adopted a non-normal distribution. 3.?Results MINOCA was found in eight individuals with APLS presenting with ACS (Table 1). Five of these individuals were female and the mean age for these individuals was 41??8?years. All eight individuals had history of prior arterial (stroke n?=?5) or venous thrombosis (n?=?4). Median troponin-I was 0.36?mg/dL [range 0.17, 0.53]. 3-Hydroxyisovaleric acid One individual was found to have diffuse coronary artery spasm, which reversed following administration of intra-coronary nitroglycerine. Six individuals had a normal ejection portion (EF). One individual experienced an EF of 30% with moderate anterolateral wall hypokinesis and inferoposterior wall akinesis. Another individual experienced global ventricular dysfunction with an EF of 40%. Six of the individuals were on long term anticoagulation with warfarin for APLS with an INR between 1.7 and 3.2 at the time of presentation. Four of the six individuals had a restorative INR (INR??2). 4.?Conversation The main getting of our study is that MINOCA is common in individuals with APLS presenting with ACS. Most of the infarctions were small, spasm played a role in two instances, and none of the instances had takotsubo-like pattern (apical ballooning) on echocardiography. The findings of this statement helped us to characterize and compare features of individuals with APLS who present.
Five of these individuals were female and the mean age for these individuals was 41??8?years