Myocardial infarction with non-obstructive coronary arteries following cisplatin and 5-fluorouracil therapy

Fluoropyrimidines and platinum compounds can induce acute coronary syndrome (ACS) and significantly contribute to morbidity in patients with cancer. A 32-year-old woman with supraglottic squamous cell carcinoma presented with acute chest pain after the first cycle of chemotherapy with cisplatin and 5-fluorouracil. Electrocardiography revealed ST elevation, and an echocardiogram revealed anteroseptal hypokinesia. Coronary angiography revealed a proximal left anterior descending artery thrombus without obstructive stenosis. Intravascular ultrasound confirmed plaque and thrombus with <50 % luminal narrowing, consistent with myocardial infarction with non-obstructive coronary arteries (MINOCA). The patient received dual antiplatelet therapy, anticoagulation, and intravenous glycoprotein PIIb/IIIa inhibitor for 24 h and was discharged after follow-up angiography showing thrombus resolution. Intravascular imaging guided the decision to avoid stenting in this non–obstructive thrombotic lesion. This case highlights the multifactorial mechanisms of ACS in cancer and the diagnostic utility of intravascular imaging, with caution against attributing events to chemotherapy alone. Contemporary MINOCA evaluation, including intracoronary imaging and cardiac MRI, is essential for defining the underlying mechanism and guiding management.