title: [Left main coronary artery aneurysm thrombosis in a young patient with acute myocardial infarction].
abstract: BACKGROUND
  The left main coronary artery aneurysm is rare, with an incidence of 0.1%, being the atherosclerosis its main etiology. Angiography is the gold standard for diagnosis and treatment. Depending on the severity of coexisting coronary stenosis, patients with left main coronary artery aneurysms can be effectively managed either surgical or pharmacologically.
  
  
  METHODS
  We present a case of a 44 year-old male with a history of obesity, smoking and dyslipidemia, complaining of oppressive chest pain, dyspnea and diaphoresis. An electrocardiogram showed an ST-segment elevation on the anterior and lateral wall and positive enzymatic curve for infarction. He was initially treated with streptokinase with no reperfusion evidence after 3 hours of the onset of symptoms, so he underwent to rescue angioplasty. Angiography reported left main coronary artery aneurysm thrombosis. Afterwards, he presented cardiogenic shock and was revascularized with a coronary artery bypass graft of the mammary artery to the left anterior descending artery and the saphenous vein to the obtuse marginal, however he did not survive. Determination for 4G/5G PAI-1 polymorphism, glycoprotein IIIa PLA1/A2 gene and Glu298Asp polymorphism of the endothelial nitric oxide synthase gene was performed.
  
  
  CONCLUSIONS
  Left main coronary artery aneurysms are rare, finding ONE in an acute myocardial infarction is a serious situation because of the challenging reperfusion techniques that are implied, such as in this case. The search for genetic factors related with hypofibrinolysis could guide stratification and therapy towards medical surgical or interventional management.
authors.affiliation: Hospital de Cardiología Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, D.F., México. iraiscris24@hotmail.com
authors.forename: Irais Cristal
authors.initials: IC
authors.lastname: Ortiz-Vázquez
authors.forename: Beatriz Carolina
authors.initials: BC
authors.lastname: Mendoza-Pérez
authors.forename: Alejandra
authors.initials: A
authors.lastname: Madrid-Miller
authors.forename: Víctor Manuel
authors.initials: VM
authors.lastname: Lozano-Torres
authors.forename: Irma
authors.initials: I
authors.lastname: Isordia-Salas
authors.forename: Gabriela
authors.initials: G
authors.lastname: Borrayo-Sánchez
mesh_terms: D000328:Adult; D000483:Alleles; D003131:Combined Modality Therapy; D003323:Coronary Aneurysm / Q000150:complications*; D003328:Coronary Thrombosis / Q000209:etiology*; D050171:Dyslipidemias / Q000150:complications; D017809:Fatal Outcome; D005342:Fibrinolysis / Q000235:genetics; D006801:Humans; D039661:Integrin beta3 / Q000235:genetics; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000209:etiology* / Q000235:genetics / Q000601:surgery; D015425:Myocardial Reperfusion; D009204:Myocardial Revascularization; D052250:Nitric Oxide Synthase Type III / Q000235:genetics; D009765:Obesity / Q000150:complications; D017395:Plasminogen Activator Inhibitor 1 / Q000235:genetics; D012770:Shock, Cardiogenic / Q000209:etiology; D012907:Smoking / Q000009:adverse effects; D013300:Streptokinase / Q000627:therapeutic use; D019851:Thrombophilia / Q000150:complications / Q000235:genetics
chemical_list: D039661:Integrin beta3; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; C496314:NOS3 protein, human; D052250:Nitric Oxide Synthase Type III; D013300:Streptokinase
keywords: Left main coronary artery aneurysm; ST elevation acute myocardial infarct; genetic markers; polymorphism