Recurrent Acute Myocardial Infarction in a Patient with Severe Coronary Artery Ectasia Followed Up for 10 Years: Implications of Anticoagulant Therapy

BACKGROUND Coronary artery ectasia (CAE) represents not only an anatomical variant but also a clinical constellation of coronary artery disease associated with acute coronary syndrome (ACS). There is no consensus on the antithrombotic treatment for patients with CEA. CASE REPORT A 34-year-old man with severe diffuse dilatation of the left main artery and left circumflex (LCX) proximal segment confirmed by coronary angiography (CAG) developed 2 acute myocardial infarctions (AMIs), due to occlusion of a dilated LCX segment with thrombus shadows, within a 9-year interval. Emergency percutaneous coronary intervention with aspiration thrombectomy failed to restore adequate blood flow at the first presentation of AMI, and the patient was eventually discharged with warfarin. After 15 months, however, he discontinued the medication on his own. After a 9-year interval, the patient experienced the second AMI, and CAG revealed occlusion of the LCX opening with thrombus shadows and collateral circulation visible from the distal segment of the right coronary artery to the circumflex branch. Thereafter, the patient began to take rivaroxaban 20 mg once daily. No chest pain or ACS events occurred during 1 year of follow-up. CONCLUSIONS This case of 2 AMI events at the CAE segment caused by local thrombus formation suggests that lifetime systemic anticoagulation therapy for secondary prevention should be considered in such cases, and a novel oral anticoagulant may be a better choice for effectively preventing thrombosis.