Type 2 Myocardial Infarction Unmasking Critical Left Main Coronary Artery Stenosis in Severe Anemia due to Addison-Biermer Disease: A Case Report

Abstrakt

To this day, myocardial infarction (MI) remains the leading cause of mortality worldwide. While its etiology is multifactorial, anemia – regard less of its underlying cause – may either accompany MI as a comorbid ity or serve as a direct precipitant of myocardial ischemia, particularly in cases of type 2 MI. Importantly, anemia diagnosed at hospital ad mission has been recognized as an independent predictor of adverse cardiovascular outcomes, including both short and longterm mortality, irrespective of its role in the pathogenesis of MI. In the case presented, severe macrocytic anemia caused by vitamin B12 deficiency resulted in acute coronary syndrome without ST-seg ment elevation (NSTE-ACS). Because of typical chest pain and deep STsegment depression in multiple leads, the patient was initially qual ified for urgent coronary angiography. In the meantime, however, mor phology results revealed severe anemia, and a noninvasive strategy was chosen. During hospitalization, the patient’s blood deficiency was corrected, the cause of anemia was identified, and treatment was in itiated. Coronary angiography was performed two months later, once blood counts had normalized, revealing significant stenosis of the distal seg ment of the left main coronary artery (LMCA) and critical ostial stenosis of the left anterior descending artery (LAD). This case report provides a starting point for discussing the optimal timing of coronary angiogra phy in the setting of NSTEACS with concomitant anemia and urges deliberate consideration of any potential delay, as well as followup treatment.