Is Acute Coronary Syndrome Secondary to Coronary Vasculitis Underestimated in Daily Cardiology Practice?

Abstract

Acute coronary syndrome (ACS) is an increasing clinical diagnosis in daily practice. ACS is a life-threatening condition with high mortality rate if left untreated. The better-known risk factors for ACS are dyslipidemia, diabetes mellitus, hypertension2 and coronary vasospasm. Coronary vasculitis is the least appreciated cause of ACS that is subject to neglect among clinicians. Coronary vasculitis (CV) may occur as a single organ vasculitis (SOV) or in the context of specific systemic vasculitides. CV may be the initial presentation of specific systemic vasculitis. Current concept indicates the “worse prognosis” in myocardial infarction associated with elevated acute phase reactants, while these could be the critical point in missed-diagnosis of occult coronary vasculitis as classic cases with atherosclerosis of coronary vessels as the culprit mechanism. We suppose that if elevated CRP/ ESR be due to inflammatory process within the vessel wall, then a classic approach of anticoagulants, thrombolytic therapy or primary coronary angioplasty paradoxically could be dangerous13 and, vice versa, different look with using glucocorticoids could be lifesaving, the medication that later on proved that can improve prognosis in ACS and MI. So, with increasing prevalence of acute coronary syndromes in younger people, the possibility of underestimating coronary vasculitis is potentiated and emphasizing only on classic and common risk factors of ACS is not prudent.