Acute Coronary Syndrome Associated with Carfilzomib Treatment

Excerpt

A 72-year-old man with a history of coronary artery disease and relapsed and refractory multiple myeloma (RRMM) presented with chest pain and shortness of breath approximately 24 h after the beginning of carfilzomib treatment (56 mg/m²/day carfilzomib). On admission, physical examination was unremarkable and electrocardiography (ECG) showed normal sinus rhythm with spread ST-segment depression and T-wave inversion in inferior and anterior precordial leads during anginal episode (Fig. 1). Baseline and follow-up cardiac troponin-I levels were within normal range. His chest pain and shortness of breath resolved after treatment with intravenous nitroglycerin and nifedipine and ECG showed normal sinus rhythm without ST-segment depression or T-wave inversion (Fig. 2). We performed coronary angiography (CAG) due to dynamic ECG changes and it revealed similar findings with previous CAG as patent left circumflex (LCx) and obtuse marginal (OM) coronary artery stents with non-obstructive coronary lesions of left anterior descending (LAD) artery and chronic total occlusion of right coronary artery (RCA) with retrograde filling via collaterals from LAD. After CAG, we speculated that the possible causes of dynamic ECG changes and chest pain were prolonged coronary vasospasm and/or endothelial dysfunction induced by carfilzomib. Treatment dose of carfilzomib for RRMM reduced with the decision of cardio-oncology council and patient discharged from hospital with dual antiplatelet, atorvastatin, valsartan, metoprolol, nifedipine and isosorbide mononitrate therapy.

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