Current Evidence in the Diagnosis and Management of Coronary Arteritis Presenting as Acute Coronary Syndrome

Coronary arteritis is a rare but life-threatening cause of coronary artery disease and could manifest as acute coronary syndrome in clinical scenarios. Coronary arteritis could occur in the setting of systematic vasculitis or being isolated. Most of these patients were lacking of conventional risk factors in atherosclerotic cardiovascular disease. Diagnosis of coronary arteritis still be difficult and often be delayed. Clinicians should take in account of comprehensive factors including the evidence of muti-organ involvement (mainly by symptoms, physical examination and radiology imaging findings) and specific laboratory test results. For the treatment of coronary arteritis, systematic drug therapy (i.e., corticosteroid and immunosuppressive therapy) combined with revascularization were applied in the most cases. However, problems of frequently in-stent restenosis and recurrent myocardial infarction still needed to be solved. It is still unclear whether revascularization is efficient and safe for these patients, and the strategy to prevent restenosis and re-ischemia still needs to be studied in the future. In this study, we reviewed the specific clinical manifestations, laboratory results, imaging findings, diagnosis criteria and therapeutic strategies for patients with coronary arteritis presented as acute coronary syndrome.