일차적 관상동맥 중재술로 치료한 진성 다혈구증 환자에서 발생한 급성 심근경색증
A successful primary coronary intervention of an acute ST elevation myocardial infarction in a patient with polycythemia vera
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초록
진성 다혈구증 환자에서 급성 심근경색증의 발생 시에 일반적인 일차적 관상동맥 중재술을 시행하였을 때 과점도 및 혈소판 기능 이상 등에 따른 급성 대동맥 폐색이나 반복적인 스텐트 혈전증 등의 발생이 보고되고 있어, 아직까지 적절한 치료가 확립되어 있지는 않다. 본 증례는 급성 ST 분절 상승 심근경색증에 대하여 좌전하행지 중간부 심한 협착 및 첫 번째 대각분지의 혈전성 폐쇄 병변에 대하여 약물 용출 관상동맥 스텐트와 풍선성형술로 치료하여 임상 증상의 호전을 보였다.
Abstract
Polycythemia vera is a chronic myeloproliferative disease characterized by clonal proliferation that arises at the level of the pluripotent stem cell and is also characterized by multiple episodes of bleeding or thrombotic complications. Rarely, polycythemia vera causes coronary arterial occlusion and can lead to ischemic heart disease. We experienced a case of acute ST elevation myocardial infarction in a 70-year-old man with polycythemia vera, who had been treated with hydoxyurea and phlebotomy since August 2005. He complained of severe chest pain of a one-hour duration and an ECG revealed an acute anterior ST elevation myocardial infarction. His leukocyte count was 18,700/mm3, red blood cell count 6,790,000/mm3, hemoglobin level 16.6 g/dL and platelet count 520,000/mm3. A diagnostic coronary angiography showed critical stenosis in the middle left anterior descending artery (LAD) and thrombotic total occlusion in the first diagonal branch (D1). Successful primary percutanenous coronary intervention was performed using a drug eluting stent in the LAD and balloon angioplasty for the D1 lesion.(Korean J Med 72:426-432, 2007)
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