A Case Report Of Acute Myocardial Infarction Caused By Coronary Embolism In A Dilated Cardiomyopathy Patient And Review Of The Literatures

Objective: To investigate the causes,diagnosis and prognosis of patient with dilated cardiomyopathy(DCM)combined with coronary embolism(CE)leading to acute myocardial infarction(AMI).Methods: The clinical data,diagnosis and treatment of one patient with DCM and coronary embolism leading to acute myocardial infarction were analyzed,and the related literatures were reviewed.Results: Diagnosed with dilated cardiomyopathy in February,2015,a 41-year-old male patient underwent routine anti-heart failure treatment.In July,2017,the patient had sudden chest pain,ST segment elevation of anterolateral wall and inferior wall on electrocardiogram(ECG)and elevated troponin I(Tn I)revealed acute ST segment elevation myocardial infarction(STEMI)on inferior wall and anterolateral wall.Coronary angiography showed abrupt ?cut-off? of mid-distal of left anterior descending(LAD)branch and first diagonal branch(D1)without obvious atherosclerosis,consistent with the manifestation of thromboembolism.The coronary artery was unobstructed after thrombus aspiration.In this case,stent was not needed.The patient received genetic analysis of thrombophilia in February,2019.We found a heterozygous frame deletion mutation in the PROC gene(c.577-579AGAdel(p.Lys193del))that encodes the protein C.The patient received a heart transplantation because the standard anti-heart failure treatment was not effective in April,2019.The postoperative myocardial pathological examination suggested pathological change of dilated cardiomyopathy.Conclusion: We found a case of dilated cardiomyopathy with acute myocardial infarction.There was no obvious atherosclerotic plaque and left ventricular thrombus in the patient with coronary thrombosis,which may be related to the risk factors of thrombosis,such as platelet hyperfunction and endothelial dysfunction caused by dilated cardiomyopathy.The gene mutation of natural anticoagulant protein C,which reduced the anticoagulant activity of protein C,may also be an important cause of coronary thrombosis.