Rapid progression of atherosclerosis in a patient with acute coronary syndrome and ANCA-associated vasculitis:split or confluence?

A59-year-old female patient was admitted to our hospital on 9 March 2021,due to recurrent chest pain.She underwent percutaneous coronary intervention,with a focus on the proximal segment of the left anterior descending(LAD)artery,six months prior to admission.The patient had a long-term history of hyperlipidaemia and obstructive sleep apnoea syndrome(OSAS).She also had rheumatoid arthritis and ANCA-associated vasculitis that lasted for more than 10 years and a 9-year history of concomitant hypertension.She was on long-term oral leflunomide and intermittent oral prednisone.The patient underwent a computed tomography angiogram(CTA)six years ago(2015),which showed minor atherosclerotic plaque build-up in the LAD artery and the right coronary artery(RCA)(Figure 1).