Primary percutaneous transluminal coronary angioplasty performed for acutemyocardial infarction in a patient with idiopathic thrombocytopenic purpura

A 72-year-old female with idiopathic thrombocytopenic purpura (ITP) complai ned of severe chest pain. Electrocardiography showed ST-segment depression and negative T wave in I, aVL and V4-6. Following a diagnosis of acute myoc ardial infarction (AMI), urgent coronary angiography revealed 99% organic s tenosis with delayed flow in the proximal segment and 50% in the middle seg ment of the left anterior descending artery (LAD). Subsequently, percutaneo us transluminal coronary angioplasty (PTCA) for the stenosis in the proxima l LAD was performed. In the coronary care unit, her blood pressure dropped. Hematomas around the puncture sites were observed and the platelet count w as 28,000/mm(3). After transfusion, electrocardiography revealed ST-segment elevation in I, aVL and V1-6. Urgent recatheterization disclosed total occ lusion in the middle segment of the LAD. Subsequently, PTCA was performed s uccessfully. Then, intravenous immunoglobulin increased the platelet count and the bleeding tendency disappeared. A case of AMI with ITP is rare. The present case suggests that primary PTCA can be a useful therapeutic strateg y, but careful attention must be paid to hemostasis and to managing the pla telet count.