Supplementary Material for: Myocardial Infarction after Ozone Therapy: Is Ozone Therapy Dr. Jekyll or Mr. Hyde?

We discuss the case of a 46-year-old male patient presenting to the emergency department with acute inferior myocardial infarction. Coronary angiography demonstrated a vasospasm of the left main coronary artery and proximal segment of the left anterior descending artery. Furthermore, a thrombotic total occlusion was ascertained in the right coronary artery. The vasospasm in the left main and left anterior descending artery disappeared after nitrate administration. We successfully implanted a stent to the thrombotic occlusion in the right coronary artery after predilatation. On detailed questioning, the patient stated that ozonated autohemotherapy had been applied that morning in a private clinic for the revitalization and regeneration of tissues. The patient did not have any traditional atherosclerotic risk factors. He denied any history of cardiac complaint. Factor V Leiden, prothrombin 20210 and MTHFR a1298c and c677t mutations were investigated and found to be negative except for MTHFR a1298c, which was a heterozygote. The levels of antithrombin III, homocysteine and protein C and S were all within normal ranges. Ozone as a medical therapy has been used in many medical conditions; unfortunately, however, like every other therapy, ozone therapy has side effects. The literature concerning ozone therapy supports possible strong vasoconstrictor and prothrombotic effects of ozone therapy, further supporting our suggestion that ozone can lead to acute coronary syndromes in human beings. In conclusion, to our knowledge, our case report reveals a possible complication of ozone therapy that has never been reported before. We think that this article will raise the awareness of the possibility of thrombotic complications after ozonated autohemotherapy.

本病例报告介绍一名46岁男性患者，因急性下壁心肌梗死前往急诊就诊。冠状动脉造影显示其左主干冠状动脉及左前降支近端节段存在血管痉挛；此外，右冠状动脉经确认存在血栓性完全闭塞。给予硝酸酯类药物治疗后，左主干及左前降支的血管痉挛得以缓解。术前行预扩张后，我们成功为右冠状动脉的血栓性闭塞病变植入支架。
经详细问诊，患者自述当日上午曾于某私立诊所接受臭氧自体血疗法（ozonated autohemotherapy），以实现组织活化与再生。该患者无任何传统动脉粥样硬化危险因素，否认既往存在心脏疾病病史。我们对其开展了莱顿第五因子（Factor V Leiden）、凝血酶原20210突变以及亚甲基四氢叶酸还原酶（MTHFR）a1298c、c677t突变的检测，结果显示除MTHFR a1298c为杂合突变外，其余检测项目均为阴性。抗凝血酶Ⅲ、同型半胱氨酸、蛋白C及蛋白S的水平均处于正常参考范围内。
臭氧作为临床治疗手段已被应用于多种病症，但与其他疗法一样，臭氧治疗同样存在不良反应。现有关于臭氧治疗的文献表明，其可能具有强烈的血管收缩及促血栓形成作用，进一步佐证了我们的推测：臭氧可诱发人类急性冠脉综合征。
综上，据我们所知，本病例报告首次揭示了臭氧治疗可能出现的一种此前未见报道的并发症。我们认为本文可提升临床医师对臭氧自体血疗法后血栓并发症发生风险的警惕性。