Acute myocardial infarction following inhaled treprostinil initiation

Abstract

An 81-year-old man with a history of interstitial lung disease attributed to idiopathic pulmonary fibrosis, severe aortic stenosis, and stable coronary artery disease was started on inhaled treprostinil for pulmonary hypertension associated with interstitial lung disease to optimize hemodynamics prior to the valve replacement procedure. However, two days after starting this treatment, the patient presented with an inferior-posterior ST elevation myocardial infarction. Urgent coronary angiography revealed a 95 % proximal right coronary artery stenosis, successfully treated with percutaneous coronary intervention and drug-eluting stent placement. This case raises a question of whether there could be a potential association between inhaled treprostinil initiation and acute myocardial infarction in patients with underlying coronary artery disease. With the documented stability of the patient's coronary artery disease prior to medication initiation, it is plausible to question whether treprostinil may have played a role in plaque destabilization.

Keywords: Acute myocardial infarction; Prostacyclin analogue; Pulmonary hypertension.

Figure-1

(A-C): Coronary Angiogram of Right Coronary Artery Fluoroscopy imaging showing coronary angiogram of the right coronary artery with proximal lesion. A) 3 years before presenting with ST-elevation myocardial infarction. B) 2 months before presenting with ST-elevation myocardial infarction. C) At the time of presenting with ST-elevation myocardial infarction.