Abstract 13574: A Rare Case of Giant Cell Arteritis With Coronary Artery Involvement

• Published in: Circulation (New York, N.Y.) Vol. 142; no. Suppl_3 Suppl 3; p. A13574
• Main Authors: Nyange, Christabel E, Toole, Joseph, Chang, William, Snyder, Matthew, Fisher, Perry
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 17-11-2020
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.142.suppl_3.13574

IntroductionCoronary artery involvement in patients with systemic vasculitis is relatively rare, but can be life threatening. There is a well-known occurrence of coronary artery vasculitis in Kawasaki disease and Takayasu arteritis, however, coronary arteritis caused by giant cell arteritis (GCA) has been documented in only a handful of reports. Case reportA 65-year-old woman with a history of GCA complicated by cerebrovascular stenosis s/p bypass and coronary artery disease (CAD) s/p DES to mid-left anterior descending (LAD) 3 years prior, without cardiac risk factors, who presented with shortness of breath and 2-3 hours of progressive non-radiating pressure like midsternal chest pain. Vital signs were stable with an unremarkable physical exam. EKG showed new T-wave inversions in V4-V6, I, II, aVL. Labs were significant for Trop T 0.17 and CRP 2.02. Echocardiogram showed EF 30% with wall motion abnormalities (ECHO 9 months prior showed EF 69% with no wall motion abnormalities). Coronary angiography revealed 99% in-stent-restenosis (ISR) of mid-LAD, 50% tubular OM1 stenosis, and 100% RCA occlusion with right-to-right collateral (figure 2). The patient underwent CABG with a left internal mammary artery graft to LAD and saphenous vein graft to RCA. Post-operative EF was 50%, and she was discharged on post-operative day 5. DiscussionIn patients with systemic vasculitis and no identifiable CAD risk factors presenting with acute coronary syndrome, there has to be a high suspicion for coronary arteritis. Our case strongly suggests that GCA can involve the coronary arteries given the rapid progression of ISR with triple vessel disease in the absence of cardiac risk factors. Although advancements in imaging techniques have led to improvements in the diagnosis of systemic vasculitis, standardized imaging for evaluating coronary vasculature is lacking. Larger retrospective case studies are needed in order to clearly delineate the association between GCA and CAD.