Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, Dijon, France.
PEC2, EA 7460, University of Burgundy, Dijon, France.
Trends Cardiovasc Med. 2024 Jan;34(1):50-56. doi: 10.1016/j.tcm.2022.07.004. Epub 2022 Jul 19.
The occurrence of coronary artery embolism (CE) has been associated with various clinical conditions, including aortic and mitral prosthetic heart valve implantation, atrial fibrillation (AF), dilated cardiomyopathy, neoplasia, infective endocarditis, atrial septal defect, cardiac tumors, and hypercoagulable states. CE is also a rare cause of myocardial infarction (MI), with a prevalence of about 5%, a figure probably underestimated. The purpose of this article was to determine the current state of knowledge on acute coronary syndrome (ACS) related to CE. We thus performed a comprehensive structured literature search of the MEDLINE database for articles published between 1 January 1990 and 31 December 2021. The diagnosis of CE remains difficult despite the currently used Shibata classification, which is based on major criteria, including angiographic characteristics: globular filling defects, saddle thrombi or multiple filling defects and absence of atherosclerosis in the coronary arteries. Suspected or confirmed CE requires the identification of an etiology. There are only two published series on CE, including about 50 cases each. The three main causes in these series were: 1) atrial fibrillation (73% vs 28.3%), 2) cardiomyopathy (9.4% vs 25%) and 3) malignancy (9.6% vs 15.1%). Finally, 26.3% of the MI patients with CE had no identifiable cause of CE. When anatomically possible, analyzing the thrombus after thrombectomy may help. MI due to CE requires systematic assessment of other locations, i.e. multiple coronary and extracardiac locations. Simultaneous systemic embolization to the brain (67%), limbs (25%), kidneys (25%) or spleen (4%) is frequent, occurring in approximately 25% of CE-related MI. In the setting of acute MI, CE is associated with significant morbidity and mortality. Coronary artery thromboembolism is a rare, non-atherosclerotic, cause of ACS, and prospective studies are needed to evaluate a systematic diagnostic approach and personalized therapeutic strategies.
冠状动脉栓塞 (CE) 的发生与多种临床情况有关，包括主动脉瓣和二尖瓣人工心脏瓣膜植入、心房颤动 (AF)、扩张型心肌病、肿瘤、感染性心内膜炎、房间隔缺损、心脏肿瘤和高凝状态。CE 也是心肌梗死 (MI) 的罕见原因，其患病率约为 5%，这一数字可能被低估了。本文的目的是确定与 CE 相关的急性冠状动脉综合征 (ACS) 的现有知识状态。因此，我们对 1990 年 1 月 1 日至 2021 年 12 月 31 日期间发表的 MEDLINE 数据库文章进行了全面的结构化文献检索。尽管目前使用的基于主要标准的 Shibata 分类法用于诊断 CE，包括血管造影特征：球形充盈缺损、鞍状血栓或多个充盈缺损以及冠状动脉无动脉粥样硬化，但 CE 的诊断仍然很困难。疑似或确诊的 CE 需要确定病因。仅有两篇关于 CE 的发表系列文章，每个系列包含约 50 例。这些系列中的三个主要病因是：1) 心房颤动 (73%比 28.3%)、2) 心肌病 (9.4%比 25%)和 3) 恶性肿瘤 (9.6%比 15.1%)。最后，26.3%的 CE 相关 MI 患者没有明确的 CE 病因。在解剖学上可行的情况下，分析血栓切除术后的血栓可能会有所帮助。CE 引起的 MI 需要对其他部位进行系统评估，即多个冠状动脉和心脏外部位。同时向大脑 (67%)、四肢 (25%)、肾脏 (25%)或脾脏 (4%)系统栓塞较为常见，在大约 25%的 CE 相关 MI 中发生。在急性 MI 中，CE 与显著的发病率和死亡率相关。冠状动脉血栓栓塞是 ACS 的一种罕见的非动脉粥样硬化病因，需要前瞻性研究来评估系统的诊断方法和个体化的治疗策略。
