无阻塞性冠状动脉疾病的心肌缺血（MINOCA）是2型急性心肌梗死（AMI）的常见原因，需要仔细的鉴别诊断。冠状动脉痉挛（CAS）综合征是导致MINOCA的病因之一。尼洛替尼,慢性粒细胞白血病（CML）的靶向治疗，据报道与不良血管事件风险增加有关.
一名67岁男性患者因急性胸痛入院。他有CML病史和尼洛替尼治疗12个月的病史。冠状动脉造影（CAG）显示无明显狭窄。由于心绞痛的发作通常在清晨，心电图和超声心动图提示右冠状动脉（RCA）疾病，进行了麦角新碱激发试验以确认CAS的诊断.冠状动脉内注射麦角新碱后，中段和远端RCA显示超过90%的血管收缩。尼洛替尼相关MINOCA，诊断为CAS和CML。生活方式的改变（戒烟），防痉挛,他汀类药物治疗和尼洛替尼剂量的调整(从200mgbid，至150mgbid）推荐给该患者。6个月的随访显示恢复良好，无心绞痛发作。
医生在治疗使用尼洛替尼的患者时，应警惕不良血管事件。建议在有尼洛替尼治疗史的MINOCA患者中，CAS诱导的MINOCA应包括在鉴别诊断中。需要进一步的研究来澄清机制并找到更好的管理。
Myocardial Ischemia with No Obstructive Coronary Artery Disease (MINOCA) is a common cause of type 2 acute myocardial infarction (AMI) which requires careful differential diagnosis. Coronary artery spasm (CAS) syndrome is one etiology that can lead to MINOCA. Nilotinib, a targeted treatment for chronic myeloid leukemia (CML), has been reported to be related with increased risk of adverse vascular events.
A 67-year-old male patient was admitted to hospital with acute chest pain. He had a past medical history of CML and a history of treatment with nilotinib for 12 months. Coronary angiography (CAG) showed no significant stenosis. Since the onset of angina was generally in the early morning, and ECG and echocardiography suggested right coronary artery (RCA) disease, an ergonovine provocation test was performed to confirm the diagnosis of CAS. After intracoronary administration of ergonovine, middle and distal RCA showed over 90% vasoconstriction. Nilotinib related MINOCA, CAS and CML were diagnosed. Lifestyle changes (cessation of smoking), anti-spasmodics, statin treatment and adjustment of the nilotinib dose (from 200 mg bid, to 150 mg bid) were recommended for this patient. Six-month\'s follow-up showed good recovery with no onsets of angina.
Physicians should be vigilant to adverse vascular events when treating patients who have been prescribed nilotinib. It is suggested that in patients with MINOCA who have a history of treatment with nilotinib, CAS-induced MINOCA should be included in the differential diagnosis. Further studies are needed to clarify the mechanism and to find better management.
