Acute Myocardial Infarction from Stent Thrombosis Following a Loss to Follow-up Triggered by Financial Barriers to PCSK9 Inhibitor Therapy
Abstract
A 44-year-old man with suspected familial hypercholesterolemia underwent percutaneous coronary intervention (PCI) with bioresorbable polymer sirolimus-eluting stent implantation for unstable angina. A proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor was initiated post-procedure but it discontinued five months later due to financial constraints, leading to a loss to follow-up and cessation of optimal medical therapy, including antiplatelet therapy. Four years later, he developed stent thrombosis, presenting as ST-elevation myocardial infarction with cardiogenic shock. Emergency PCI with Impella support achieved successful revascularization. This case emphasizes that beyond clinical efficacy, attention to financial feasibility and shared decision-making is essential for the long-term success of therapies such as PCSK9 inhibitors.
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BibTeX
@article{nagao2026acute,
title = {{Acute Myocardial Infarction from Stent Thrombosis Following a Loss to Follow-up Triggered by Financial Barriers to PCSK9 Inhibitor Therapy}},
author = {Tetsuro Nagao and Riku Arai and Tokio Nishiwaki and Yudai Tanaka and Koichiro Hori and Yasunari Ebuchi and Yasuo Okumura},
journal = {Internal Medicine},
year = {2026},
month = aug,
doi = {10.2169/internalmedicine.6453-25},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/65/16/65_6453-25/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Acute Myocardial Infarction from Stent Thrombosis Following a Loss to Follow-up Triggered by Financial Barriers to PCSK9 Inhibitor Therapy
AU - Tetsuro Nagao
AU - Riku Arai
AU - Tokio Nishiwaki
AU - Yudai Tanaka
AU - Koichiro Hori
AU - Yasunari Ebuchi
AU - Yasuo Okumura
PY - 2026
DA - 2026/08/15
JO - Internal Medicine
DO - 10.2169/internalmedicine.6453-25
UR - https://www.jstage.jst.go.jp/article/internalmedicine/65/16/65_6453-25/_article
AB - A 44-year-old man with suspected familial hypercholesterolemia underwent percutaneous coronary intervention (PCI) with bioresorbable polymer sirolimus-eluting stent implantation for unstable angina. A proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor was initiated post-procedure but it discontinued five months later due to financial constraints, leading to a loss to follow-up and cessation of optimal medical therapy, including antiplatelet therapy. Four years later, he developed stent thrombosis, presenting as ST-elevation myocardial infarction with cardiogenic shock. Emergency PCI with Impella support achieved successful revascularization. This case emphasizes that beyond clinical efficacy, attention to financial feasibility and shared decision-making is essential for the long-term success of therapies such as PCSK9 inhibitors.
SN - 1349-7235
SN - 0918-2918
ER -