Yutani C, Imakita M, Ueda-Ishibashi H, Katsuragi M, Fujita H
Department of Pathology, National Cardiovascular Center, Suita, Japan.
Mod Pathol. 1992 May;5(3):244-9.
Since 1978, there have been sporadic reports of coronary artery embolism caused by cardiac catheterization, percutaneous transluminal coronary angioplasty, and other invasive procedures. To determine whether coronary artery embolism has increased with the wider application of such procedures, we searched for patients with coronary artery emboli among the autopsy cases with suspected acute myocardial infarction at the National Cardiovascular Center from 1977 to 1990. Of the 28 patients with emboli, 10% of the total autopsy cases of myocardial infarction was confirmed in 18. Infarction was diagnosed clinically in only six of these patients and directly caused the death of 11 of the 18 patients. In contrast to previous reports, where a minority of coronary emboli were caused by instrumentation, 14/28 patients in our series had coronary embolism due to invasive procedures, including eight patients with atheromatous emboli. half of the myocardial infarcts caused by embolism were hemorrhagic. Thus, coronary emboli are not so rare as once thought, and they may increase further with the progress of invasive diagnostic and surgical interventions. The possibility of coronary embolism thus needs to be kept in mind by all clinicians in the cardiovascular fields.
自1978年以来，陆续有关于心脏导管插入术、经皮腔内冠状动脉成形术及其他侵入性操作引发冠状动脉栓塞的报道。为确定随着此类操作的广泛应用冠状动脉栓塞是否有所增加，我们在1977年至1990年期间于国立心血管中心对疑似急性心肌梗死的尸检病例中查找冠状动脉栓塞患者。在28例有栓塞的患者中，18例（占心肌梗死尸检病例总数的10%）得到确诊。这些患者中仅有6例临床诊断为梗死，并且18例患者中有11例直接死于梗死。与之前少数冠状动脉栓塞由器械操作引起的报道不同，我们系列研究中的28例患者中有14例因侵入性操作导致冠状动脉栓塞，其中8例为动脉粥样硬化栓子。栓塞所致的心肌梗死半数为出血性。因此，冠状动脉栓塞并非像曾经认为的那样罕见，并且随着侵入性诊断和外科干预的进展可能会进一步增加。心血管领域的所有临床医生都需要牢记冠状动脉栓塞的可能性。
