ArticleJACC. Case reports2026
Anti-HMGCR Myopathy During NSTEMI Evaluation: The Statin Paradox and Troponin Trap.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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10 authors.
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Abstract
backgroundAnti-3-hydroxy-3-methylglutaryl coenzyme A reductase immune-mediated necrotizing myopathy causes progressive proximal weakness with marked creatine kinase elevation that persists after statin cessation. High-sensitivity troponin T may be elevated in inflammatory myopathies independent of myocardial ischemia, complicating acute coronary syndrome evaluation. CASE SUMMARY: A 69-year-old man presented after a fall with progressive proximal weakness. Rising high-sensitivity troponin T levels prompted non-ST-segment elevation myocardial infarction work-up; angiography revealed severe multivessel coronary artery disease including left main involvement. Concurrent creatine kinase of 4,356 U/L and transaminitis led to myopathy evaluation. Anti-3-hydroxy-3-methylglutaryl coenzyme A reductase antibody was strongly positive (459), and thigh magnetic resonance imaging confirmed diffuse myositis. Statins were discontinued; immunotherapy was escalated to pulse methylprednisolone, intravenous immunoglobulin, and methotrexate. DISCUSSION: This case highlights a management collision: urgent coronary revascularization planning vs absolute statin contraindication requiring rapid immunosuppression for immune-mediated necrotizing myopathy.
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