Calero-Núñez Sofía, Ferrer Bleda Vicente, Corbí-Pascual Miguel, Córdoba-Soriano Juan Gabriel, Fuentes-Manso Raquel, Tercero-Martínez Antonia, Jiménez-Mazuecos Jesús, Barrionuevo Sánchez María Isabel
Department of Cardiology, Albacete University Hospital, C/Hermanos Falcó 37, 02006 Albacete, Spain.
Coronary Care Unit, Albacete University Hospital, C/Hermanos Falcó 37, 02006 Albacete, Spain.
Eur Heart J Case Rep. 2018 Mar 23;2(1):yty032. doi: 10.1093/ehjcr/yty032. eCollection 2018 Mar.
Embolic myocardial infarction is an uncommon but increasingly recognized complication of infective endocarditis (IE). Its incidence ranges between 1% and 10%, but it has a high mortality rate. A high index of suspicion is required to diagnose it. Only case reports and small studies on this condition have been published; thus, it is unknown what the ideal treatment is. We review the challenges to diagnosing this disease and the most effective treatments for it.
We report a case series of three patients with acute coronary syndrome (ACS) in IE. The first patient presented with non-ST-elevation ACS. He underwent a stent placement for late-diagnosed embolic myocardial infarction, after which he was treated conservatively without valve replacement, with good results. The second patient with ST-elevation presented with ACS, for which conventional balloon angioplasty and successful double valve replacement were performed. ST-elevation ACS was also observed in the last patient, who experienced periannular complications, which necessitated surgery.
Acute coronary syndrome is a rare complication of IE but is associated with an increased risk of heart failure and high mortality rate. Its management is complicated and cannot be standardized. Because each situation is unique, a multidisciplinary discussion is required to choose the best treatment.
栓塞性心肌梗死是感染性心内膜炎（IE）一种罕见但日益被认识到的并发症。其发病率在1%至10%之间，但死亡率很高。诊断该病需要高度的怀疑指数。关于这种情况仅发表了病例报告和小型研究；因此，尚不清楚理想的治疗方法是什么。我们回顾了诊断这种疾病的挑战以及最有效的治疗方法。
我们报告了一组3例感染性心内膜炎合并急性冠状动脉综合征（ACS）的病例。首例患者表现为非ST段抬高型急性冠状动脉综合征。他因延迟诊断的栓塞性心肌梗死接受了支架置入术，之后接受保守治疗，未进行瓣膜置换，效果良好。第二例ST段抬高型患者表现为急性冠状动脉综合征，为此进行了传统球囊血管成形术并成功进行了双瓣膜置换。最后一例患者也出现了ST段抬高型急性冠状动脉综合征，伴有瓣周并发症，需要进行手术。
急性冠状动脉综合征是感染性心内膜炎的一种罕见并发症，但与心力衰竭风险增加和高死亡率相关。其治疗复杂且无法标准化。由于每种情况都是独特的，因此需要进行多学科讨论以选择最佳治疗方法。
