Glucose-6-Phosphate Dehydrogenase (G6PDH) Deficiency in a Patient with ST-Segment Elevation Acute Myocardial Infarction Successfully Treated by Simple Thrombectomy

Abstract

We report the case of an 82-year-old Sardinian woman affected by "favism" (i.e. intolerance to fava beans) with chest pain associated with persistent massive ST elevation in V2-V6 leads, admitted to our department after transfer from a rural hospital without catheterization facilities. On immediate transfer to the catheterization laboratory for primary percutaneous intervention (PCI), coronary angiogram showed proximal left anterior descending (LAD) thrombotic occlusion. In consideration of her history of glucose-6 phosphate dehydrogenase deficiency and "loss of consciousness" at a young age after taking aspirin, which contraindicated aspirin therapy, we treated this patient using a new, two-step strategy, with an emergency minimalist intervention using manual thrombectomy and intracoronary glycoprotein b/ a (GP b a) inhibition with abciximab. Subsequent angiography control confirmed the persistence of Thrombolysis in Myocardial Infarction Trial (TIMI) grade 3 flow and the presence of an intermediate proximal LAD coronary lesion, which was not treated, also due to the persisting contraindication to aspirin. In our opinion, minimalist intervention with a thrombectomy device (especially in patients characterized by a high intracoronary thrombus burden) and/or with the use of a small balloon or gentle dilation, sustained by maximized antithrombotic therapy may represent an interesting and rational approach, allowing interventionalists to postpone stenting in the setting of primary PCI in special cases. J Atheroscler Thromb, 2011; 18:425-430.Key words; Favism, Myocardial infarction, Manual thrombectomy cessfully treated this patient using a two-step strategy, with an emergency minimalist intervention using manual thrombectomy and intracoronary glycoprotein b/ a (GP b a) inhibition with abciximab. This case shows that an aggressive, thrombectomyonly strategy may be sufficient to restore flow in an emergency, and recanalization may be sustained by a maximized antithrombotic regimen (abcximab, clopidogrel and heparin) allowing interventionalists to postpone stenting in the setting of primary PCI in special cases. Case PresentationA 82-year-old hypercholesterolemic Sardinian woman with chest pain of one-hour duration, associated with persistent massive ST elevation in V2-V6 leads, was admitted to our department after transfer

Antiplatelet and invasive treatment in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency and acute coronary syndrome. The safety of aspirin

“…There are only a few reports on the long‐term safety of ASA in patients with favism . Moreover, reports are even fewer regarding the long‐term safety and efficacy of DAPT in patients with G6PD deficiency needing PCI with DES, and thus, no official guidelines are available …”

“…The limited data available on the safety of ASA in patients with favism and ACS are rather contradictory. Porto et al . describe a case of anterior STEMI treated in the acute phase using manual thrombectomy and intracoronary IIb/IIIa glycoprotein inhibition with abciximab without any attempt to implant a stent.…”

“…11 Moreover, reports are even fewer regarding the long-term safety and efficacy of DAPT in patients with G6PD deficiency needing PCI with DES, and thus, no official guidelines are available. 12,13 The limited data available on the safety of ASA in patients with favism and ACS are rather contradictory. Porto et al 12 describe a case of anterior STEMI treated in the acute phase using manual thrombectomy and intracoronary IIb/IIIa glycoprotein inhibition with abciximab without any attempt to implant a stent.…”

“…12,13 The limited data available on the safety of ASA in patients with favism and ACS are rather contradictory. Porto et al 12 describe a case of anterior STEMI treated in the acute phase using manual thrombectomy and intracoronary IIb/IIIa glycoprotein inhibition with abciximab without any attempt to implant a stent. Seven days later, a repeat angiography showed a Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow and the presence of an intermediate proximal LAD lesion which was not treated due to the existing history of G6PD deficiency and 'loss of consciousness' at a younger age after taking aspirin.…”

Dual Antiplatelet Therapy in Patients with Glucose-6-Phosphate Dehydrogenase Deficiency undergoing PCI with Drug-Eluting Stents

“…To the best of our knowledge, there are only three single case reports describing the clinical management of such patients undergoing PCI for ischaemic heart disease (IHD) ( Table 1) [7][8][9] . In the current work, we report the history and management of five patients with G6PD deficiency and IHD, discuss our internal protocol for managing these patients and provide an overview of the available data, with particular regard to DAPT management.…”