Coronary embolism causing acute myocardial infarction. Review of the literature

Abstract

Coronary artery embolism (CE) should be considered as a nonatherosclerotic cause of acute myocardial infarction (AMI), especially in patients with conditions favouring the formation of intracardiac thrombi. The main aetiologies of CE have changed in recent decades. Currently, atrial fibrillation is the most common cause. Most studies on CE infarcts are case reports with small numbers of patients. There are still no clear guidelines for the management in embolic myocardial infarction. Depending on the aetiology, the treatment needs to be tailored individually. As long-term outcomes indicate, patients with CE causing AMI are at high-risk and therefore require close follow-up. StreszczenieZator tętnicy wieńcowej należy podejrzewać w przypadku ostrego zespołu wieńcowego u pacjentów bez choroby miażdży-cowej, ale z czynnikami ryzyka sprzyjającymi powstawaniu skrzeplin wewnątrzsercowych. Najważniejsze etiologie zatoru tętnic wieńcowych zmieniały się w ciągu ostatnich dekad. Obecnie za najczęstszą przyczynę uznaje się migotanie przedsionków. Większość prac na temat zawałów spowodowanych zatorem tętnicy wieńcowej to opisy przypadków z niewielką liczbą przedstawionych pacjentów. Niestety nadal nie ma jasnych wytycznych co do diagnostyki oraz leczenia zatoru tętnic wieńcowych. W zależności od etiologii leczenie powinno być dopasowane indywidualnie. Jak wskazują wyniki długoter-minowych obserwacji, pacjenci z zawałem w wyniku zatoru tętnicy wieńcowej stanowią grupę wysokiego ryzyka, która wymaga dokładnej obserwacji.Approximately 5% of all patients with acute myocardial infarction (AMI) do not have atherosclerotic coronary artery disease [1]. Coronary artery embolism (CE) should be suspected in patients with factors or comorbidities predisposing to embolic events, who develop severe chest pain with elevated cardiac enzymes. Large diversity of aetiologies makes the precise diagnosis challenging. Most studies on coronary artery embolic infarcts are case reports with a small number of patients. There are still no clear guidelines for diagnostic criteria and the management of such cases. The approach of this paper is to provide a literature review of the CE causing AMI.Results from research by Prizel et al. revealed the incidence of coronary artery embolic infarcts in 55 out of 419 patients, which comprised 13% of autopsy-studied infarcts [2]. In another recent mechanistic study, based on analysis of 1776 patients with de novo AMI, the prevalence of CE was 2.9% [3]. The growing importance of invasive diagnostic and therapeutic methods provides a wealth of information about CE and its aetiology. There are a number of causes of coronary artery embolism. Analysis of the four main autopsy studies reported in the literature [4][5][6] with additional recently published mechanistic study [3], shows how the aetiology of CE has varied over the last half-century. Initially infective endocarditis accounted for more than half of all cases, then with the widespread use of antibiotics non-infected valvular heart disease became more ...

Mortality of women with ST-segment elevation myocardial infarction and cardiogenic shock – results from the PL-ACS registry

“…The main cause of CS in the early hours of STEMI is acute left ventricular failure resulting from a massive necrosis or some combination of a moderate necrosis and muscle freezing in the adjacent areas. Mechanical complications of MI as well as other rare cause are also reported [2]. The SHOCK trial clearly showed benefits from the use of an early revascularization strategy.…”

Myocardial infarction due to coronary embolism in a patient with dilated cardiomyopathy without atherosclerotic lesions on coronary angiography

“…-4,3% (4) . Zatorowość tętnic wieńcowych jako potencjalną przyczynę ostrego zespołu wieńcowego należy podejrzewać u pacjentów bez choroby miażdżycowej udowodnionej w koronarografii, ale z czynnikami ryzyka sprzyjającymi powstawaniu skrzeplin wewnątrzsercowych (5) . Etiologia zatorowości tętnic wieńcowych na przestrzeni lat się zmieniła.…”

Myocardial infarction with non-obstructive coronary arteries

“…At the time of angiography, no clinically overt specific cause is present. bility or rare cases of paradoxical embolisation [11]. The guidelines do not include peri-partum cardiomyopathy (PPCM) as a potential trigger of MINOCA; however, a presentation of typical acute retrosternal chest pain in a young breast-feeding female together with STEMI pattern on ECG and significant cTn rise is highly suggestive of acute MI, and many such patients undergo coronary angiography.…”