Nilotinib related acute myocardial infarction with nonobstructive coronary arteries: a case report and literature review

• Published in: BMC cardiovascular disorders 2022-02, Vol.22 (1), p.46-6, Article 46
• Main Authors: Chen, Weiwei, Du, Beibei, Liu, Kun, Yu, Zhixi, Wang, Xingtong, Yang, Ping
• Format: Article
• Language: English
• Subjects: Aged; Angina; Angina pectoris; Angiography; Antineoplastic Agents - adverse effects; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Case Report; Case studies; Chronic myeloid leukemia; Complications and side effects; Coronary arteries; Coronary artery; Coronary artery spasm; Coronary vessels; Differential diagnosis; Echocardiography; Electrocardiography; Ergonovine provocation test; Etiology; Health aspects; Heart attack; Heart attacks; Heart diseases; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Ischemia; Leukemia; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - drug therapy; Lifestyles; Literature reviews; Male; MINOCA - chemically induced; MINOCA - diagnostic imaging; MINOCA - therapy; Myeloid leukemia; Myocardial infarction; Myocardial ischemia; Myocardial Ischemia with No Obstructive Coronary Artery Disease; Nilotinib; Pain; Patient outcomes; Patients; Physiological aspects; Protein Kinase Inhibitors - adverse effects; Pyrimidines - adverse effects; Risk factors; Smoking Cessation; Stenosis; Treatment Outcome; Trinucleotide repeats; Vascular adverse events; Vasoconstriction; Vasodilator Agents - therapeutic use; Vein & artery diseases
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-022-02504-0

Myocardial Ischemia with No Obstructive Coronary Artery Disease (MINOCA) is a common cause of type 2 acute myocardial infarction (AMI) which requires careful differential diagnosis. Coronary artery spasm (CAS) syndrome is one etiology that can lead to MINOCA. Nilotinib, a targeted treatment for chronic myeloid leukemia (CML), has been reported to be related with increased risk of adverse vascular events. A 67-year-old male patient was admitted to hospital with acute chest pain. He had a past medical history of CML and a history of treatment with nilotinib for 12 months. Coronary angiography (CAG) showed no significant stenosis. Since the onset of angina was generally in the early morning, and ECG and echocardiography suggested right coronary artery (RCA) disease, an ergonovine provocation test was performed to confirm the diagnosis of CAS. After intracoronary administration of ergonovine, middle and distal RCA showed over 90% vasoconstriction. Nilotinib related MINOCA, CAS and CML were diagnosed. Lifestyle changes (cessation of smoking), anti-spasmodics, statin treatment and adjustment of the nilotinib dose (from 200 mg bid, to 150 mg bid) were recommended for this patient. Six-month's follow-up showed good recovery with no onsets of angina. Physicians should be vigilant to adverse vascular events when treating patients who have been prescribed nilotinib. It is suggested that in patients with MINOCA who have a history of treatment with nilotinib, CAS-induced MINOCA should be included in the differential diagnosis. Further studies are needed to clarify the mechanism and to find better management.