Allergy Associated Myocardial Infarction: A Comprehensive Report of Clinical Presentation, Diagnosis and Management of Kounis Syndrome

• Main Authors: Anastasopoulou, M. (Author), Davlouros, P. (Author), Hahalis, G. (Author), Koniari, I. (Author), Kounis, N.G (Author), Mplani, V. (Author), Roumeliotis, A. (Author), Tsigkas, G. (Author)
• Format: Article
• Language: English
• Published: MDPI 2022
• Subjects: acetylsalicylate aluminum; acetylsalicylic acid; acute coronary syndrome; Acute coronary syndrome; acute pancreatitis; adult; allergic reaction; Allergy; amiodarone; amoxicillin; amoxicillin plus clavulanic acid; anaphylaxis; Anaphylaxis; anesthetic agent; angiotensin receptor antagonist; antibiotic agent; Article; beta adrenergic receptor blocking agent; calcium channel blocking agent; carboplatin; cardiovascular disease; cardiovascular risk; cefaclor; cefazolin; cefotaxime; ceftazidime; cephalosporin; ciprofloxacin; clarithromycin; clindamycin; controlled study; coronary artery; daratumumab; demography; diabetes mellitus; diclofenac; differential diagnosis; dyslipidemia; dyspnea; electrocardiography; female; fluconazole; fly bite; gadoteric acid; gemifloxacin; heart infarction; hospitalization; human; hypersensitivity; hypertension; hypotension; insect bite; Kounis syndrome; Kounissyndrome; levofloxacin; lidocaine; major clinical study; male; medical history; metronidazole; middle aged; nausea and vomiting; non insulin dependent diabetes mellitus; obesity; oxaliplatin; paclitaxel; penicillin G; pruritus; rash; restenosis; revascularization; right coronary artery; rituximab; smoking; ST segment elevation myocardial infarction; stent thrombosis; sugammadex; sultamicillin; takotsubo cardiomyopathy; telithromycin; thorax pain; troponin I; tryptase; urticaria; vancomycin; vasospasm
• Online Access: View Fulltext in Publisher

 Kounis syndrome (KS) has been defined as acute coronary syndrome (ACS) in the context of a hypersensitivity reaction. Patients may present with normal coronary arteries (Type I), established coronary artery disease (Type II) or in-stent thrombosis and restenosis (Type III). We searched PubMed until 1 January 2020 for KS case reports. Patients with age <18 years, non-coronary vascular manifestations or without an established diagnosis were excluded. Information regarding patient demographics, medical history, presentation, allergic reaction trigger, angiography, laboratory values and management were extracted from every report. The data were pulled in a combined dataset. From 288 patients with KS, 57.6% had Type I, 24.7% Type II and 6.6% Type III, while 11.1% could not be classified. The mean age was 54.1 years and 70.6% were male. Most presented with a combination of cardiac and allergic symptoms, with medication being the most common trigger. Electrocardiographically, 75.1% had ST segment elevation with only 3.3% demonstrating no abnormalities. Coronary imaging was available in 84.8% of the patients, showing occlusive lesions (32.5%), vascular spasm (16.2%) or normal coronary arteries (51.3%). Revascularization was pursued in 29.4% of the cases. In conclusion, allergic reactions may be complicated by ACS. KS should be considered in the differential diagnosis of myocardial infarction with non-obstructive coronary arteries. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.