Acute coronary embolism: Angiographic diagnosis and treatment with primary angioplasty

Hernández, Felipe; Pombo, Marta; Dalmau, Regina; Andreu, Javier; Alonso, Manuel; Albarrán, Agustín; Velázquez, María T.; Tascón, Juan

doi:10.1002/ccd.10122

Cited by 45 publications

(38 citation statements)

References 10 publications

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“…In general, the diagnosis of CE has been made based on conventional angiographic features specific for coronary occlusion such as globular filling defects, 16 horse-riding thrombi, 8 or multiple filling defects 33 plus a couple of the following characteristics: (1) no atherosclerotic findings in the coronary trees, (2) presence of predisposing factors or comorbidities (ie, AF, intracardiac prosthesis, infective endocarditis, mural thrombus, or cardiac tumor), or (3) absence of significant stenosis at the culprit lesion after thrombus aspiration.…”

Section: Proposed Criteria For the Clinical Diagnosis Of Cementioning

confidence: 99%

Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Attributable to Coronary Artery Embolism

et al. 2015

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Atrial fibrillation (AF) is associated with a high risk of thromboembolic events, and its prevalence is projected to increase because of population aging. 17 Indeed, the thromboembolic complications of AF are an important cause of morbidity and mortality. The CHADS 2 and CHA 2 DS 2 -VASc scores are useful for thromboembolic risk stratification. 18,19 Background-Coronary artery embolism (CE) is recognized as an important nonatherosclerotic cause of acute myocardial infarction. Its prevalence, clinical features, and prognosis remain insufficiently characterized. Methods and Results-We screened 1776 consecutive patients who presented with de novo acute myocardial infarction between 2001 and 2013. CE was diagnosed based on criteria encompassing histological, angiographic, and other diagnostic imaging findings. The prevalence, clinical characteristics, treatment strategies, in-hospital outcomes, and long-term risk of CE recurrence or major adverse cardiac and cerebrovascular events (cardiac death, fatal arrhythmia, or recurrent thromboembolism) were evaluated. The prevalence of CE was 2.9% (n=52), including 8 (15%) patients with multivessel CE. Atrial fibrillation was the most common cause (n=38, 73%). Only 39% of patients with CE were treated with vitamin K antagonists, and the median international normalized ratio was 1.42 (range, 0.95-1.80). Eighteen of the 30 CE patients with nonvalvular atrial fibrillation had a CHADS 2 score of 0 or 1. When those patients were reevaluated using CHA 2 DS 2 -VASc, 61% were reassigned to a higher risk category. During a median follow-up of 49 months, CE and thromboembolism recurred in 5 atrial fibrillation patients. The 5-year rate of major adverse cardiac and cerebrovascular events was 27.1%. In the propensity score-matched cohorts (n=45 each), Kaplan-Meier analysis showed a significantly higher incidence of cardiac death in the CE group than in the non-CE group (hazard ratio, 9.29; 95% confidence interval, 1.13-76.5; P<0.001). Correspondence to Teruo Noguchi, MD, PhD, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Japan. E-mail tnoguchi@hsp. The present study was designed to evaluate the prevalence, clinical characteristics, and initial management of CE, and early and late outcomes, as well, in a large consecutive series of patients. We also propose new diagnostic criteria for CE based on histological, angiographic, and other diagnostic imaging findings. Conclusions-Atrial Methods Study Population and PCI ProcedureWe retrospectively analyzed a total of 2135 consecutive patients with AMI from January 2001 to December 2013 in the National Cerebral and Cardiovascular Center AMI database. We excluded 359 patients with a history of previous myocardial infarction (n=241), PCI (n=90), coronary artery bypass grafting (n=18), or both PCI and coronary artery bypass grafting (n=10), resulting in a total of 1776 patients with de novo AMI that were ultimately analyzed in this study (Figure 1). All study patients under...

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Section: Proposed Criteria For the Clinical Diagnosis Of Cementioning

confidence: 99%

Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Attributable to Coronary Artery Embolism

et al. 2015

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“…For early AMI with ST segment elevation, there are currently two available treatments, intravenous thrombolysis and percutaneous intervention. Some literatures have reported that intravenous thrombolysis could be chosen for the treatment of this kind of coronary (25). Treatment methods using suction to deal with emboli inside the coronary artery have been reported (5,17,26,27).…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis of acute myocardial infarction caused by coronary embolism

et al. 2017

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IntroductionAcute myocardial infarction (AMI) is very common in clinic, and is often caused by incomplete coronary occlusion or complete occlusion induced by acute plaque rupture (1). Coronary angiography plays an important role in the etiology diagnosis and treatment of AMI (2). In previous studies, 1-12% of patients with AMI who underwent coronary angiography did not develop an irregular lumen, or coronary artery stenosis of <50% (3,4). In this type of AMI, causes of infarct-related artery occlusion vary from person to person, such as increased platelet or coagulation activity (hypercoagulability) (5-7), coronary artery spasm (8), coronary artery embolism (9,10), as well as coronary myocardial bridge, coronary artery ectasia and coronary artery dissection (11). AMI caused by coronary artery embolism is rare in clinical practice. This study conducts an analysis of the clinical characteristics of these patients. MethodsFrom 2005 to 2015, five patients with AMI caused by coronary artery embolism were admitted to our hospital, and underwent primary percutaneous coronary intervention Original Article

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“…In the setting of inadequate anticoagulation acute occlusive embolism to coronary arteries successfully treated with percutaneous transluminal coronary angioplasty (PTCA) in patients with mechanical prosthetic aortic valves has been described in random case reports (7).…”

Section: Discussionmentioning

confidence: 99%

Successful application of thrombolysis and angioplasty in case of mechanical aortic valve and coronary graft thrombosis

Norkienė

Kažukauskienė

Samalavičius

et al. 2016

AML

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Prosthetic valve thrombosis (PVT) is a rare and fatal complication requiring immediate treatment. Optimal management of the left-sided obstructive PVT is still controversial and depends on patient's status, estimated risk of surgery, thrombus location and size, and clinician's experience. We report a case of a 71-year-old woman, presenting with signs of cardiogenic shock. Transesophageal echoscopy was used to diagnose acute obstructive thrombosis of the mechanical aortic valve. Concomitant coronary graft thrombosis was suspected due to signs of acute myocardial infarction. Thrombolysis with alteplase and subsequent stenting of the venous graft lead to successful resolution of the thrombotic lesions and a favourable patient outcome. Fibrinolytic therapy followed by angioplasty is a rational treatment alternative for inoperable or high risk patients in the case of concomitant mechanical valve and graft thrombosis.

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Acute coronary embolism: Angiographic diagnosis and treatment with primary angioplasty

Cited by 45 publications

References 10 publications

Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Attributable to Coronary Artery Embolism

Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Attributable to Coronary Artery Embolism

Clinical analysis of acute myocardial infarction caused by coronary embolism

Successful application of thrombolysis and angioplasty in case of mechanical aortic valve and coronary graft thrombosis

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