Early Onset Acute Coronary Artery Occlusion After Pembrolizumab in Advanced Non-Small Cell Lung Cancer: A Case Report

Myocarditis, arrhythmia, and cardiomyopathy are the most reported acute cardiotoxicities in cancer patients receiving immune checkpoint inhibitor (ICI) therapy. But it is not clear whether ICI can cause acute coronary occlusive disease. We reported acute coronary artery occlusion in an 83-year-old male non-small cell lung cancer (NSCLC) patient after 2 days of pembrolizumab infusion. This patient had a server-underlying three-vessel coronary artery disease without symptoms. The patient was discharged from the hospital two weeks after percutaneous coronary intervention. Pembrolizumab may cause destabilization of severely stenosed atherosclerotic plaques, which contributes to acute myocardial infarction. We should take more caution about lung cancer patients with baseline coronary disease when treat with ICI. CRP may be a useful predictor factor of early-onset coronary events in these patients.