Khawar Abbass Kazmi
Aga Khan University Hospital Karachi, Pakistan
Title: PCI in a patient with acute coronary syndrome, cardiogenic shock and thrombocytopenia secondary to MDS
Biography
Biography: Khawar Abbass Kazmi
Abstract
Introduction: Cardiogenic shock occurs in 2.5% patients with non ST elevation myocardial infarction as compared to 5-8% of patients with ST elevation myocardial infarction. Percutaneous Coronary Intervention for ischemia related cardiogenic shock in patients with myelodysplastic syndrome and thrombocytopenia presents a unique challenge for the interventional cardiologist and hematologist. The patient in our case report presented with non ST elevation myocardial infarction, severe thrombocytopenia and cardiogenic shock. He had in-stent restenosis in prior bare metal stents and was declined for CABG, limiting the treatment options. This is the first case report of percutanous coronary intervention for in-stent restenosis in myelodysplastic syndrome. The procedure was successful and patient did well on one year follow up. Case Presentation: A 66 year old gentleman presented with NSTEMI and cardiogenic shock. He underwent left heart catheterization that revealed significant in-stent restenosis of LAD and 70% disease in the LCx. He underwent successful PCI of LAD and LCX with newer generation drug eluting stents. There were no bleeding complications observed during the course of his hospital stay and did well on one year follow up, which was the very crucial period regarding antiplatelet therapy. Conclusion: Percutaneous coronary intervention in patients with myelodysplastic syndrome is challenging as there is always a risk of the patient developing bleeding complications secondary to anticoagulation and/or antiplatelet therapy. Our case report describes a successful coronary intervention in patient with in-stent restenosis, where CABG was denied due to his medical condition.