Chang Shufu, Xu Rende, Dai Yuxiang, Li Chenguang, Lu Hao, Qin Qing, Ma Jianying, Qian Juying, Ge Junbo
Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180, Fenglin Road, Shanghai, 200032, China.
National Clinical Research Center for Interventional Medicine, Shanghai, China.
Eur J Med Res. 2025 Jul 21;30(1):641. doi: 10.1186/s40001-025-02914-8.
Coronary embolism (CE) is rare and is an unusual cause of acute myocardial infarction (AMI). Japan NCVC criteria of CE were the first criteria that did not be verified and accepted.
We collected all the CE patients in our hospital between 2015 and 2021, analyzed the characters, diagnosis, and treatment, and confirmed the value of Japan NCVC criteria.
Eighteen AMI patients diagnosed with CE were enrolled. Seventeen patients (94.4%) were given PCI treatments. Six patients (33.3%) had artificial heart valves, and three (16.7%) had mechanical valves. Eleven patients (61.1%) had atrial fibrillation (AF), one (5.6%) had hypertrophic cardiomyopathy, and two (11.1%) had hypercoagulable state. 68.8% of patients had insufficient anticoagulation in this study. Seven patients (38.9%) fulfilled the criteria for definite CE, and nine (50%) were classified as probable CE. The other two patients (11.1%) did not fulfill the criteria of CE with distal coronary artery embolism and one criterion of Japan NCVC criteria. The diagnosis accuracy rate of Japan NCVC criteria was 88.9%. Thrombus aspiration was the first-line treatment used in 14 patients (77.8%) and performed in 9 vessels (47.4%) as the only treatment method.
CE is rare in AMI, and AF is the most critical cause which should draw our attention. The Japan NCVC criteria were a helpful diagnostic tool for CE with high accuracy, but the distal coronary artery embolism with moderate atherosclerosis might be overlooked. Thrombus aspiration was the preferred treatment to remove thrombus and restore coronary flow to improve prognosis.
冠状动脉栓塞（CE）较为罕见，是急性心肌梗死（AMI）的一种不常见病因。日本CE的NCVC标准是首个未经验证和被接受的标准。
我们收集了2015年至2021年我院所有的CE患者，分析其特征、诊断及治疗情况，并确认日本NCVC标准的价值。
纳入18例诊断为CE的AMI患者。17例患者（94.4%）接受了PCI治疗。6例患者（33.3%）有人工心脏瓣膜，3例（16.7%）有机械瓣膜。11例患者（61.1%）有房颤（AF），1例（5.6%）有肥厚型心肌病，2例（11.1%）有高凝状态。本研究中68.8%的患者抗凝不足。7例患者（38.9%）符合确诊CE的标准，9例（50%）被归类为可能的CE。另外2例患者（11.1%）不符合远端冠状动脉栓塞的CE标准及日本NCVC标准中的一项标准。日本NCVC标准的诊断准确率为88.9%。14例患者（77.8%）将血栓抽吸作为一线治疗方法，其中9支血管（47.4%）将其作为唯一治疗方法。
CE在AMI中罕见，AF是最应引起我们关注的关键病因。日本NCVC标准是诊断CE的有用工具，准确性高，但中度动脉粥样硬化的远端冠状动脉栓塞可能被忽视。血栓抽吸是清除血栓和恢复冠状动脉血流以改善预后的首选治疗方法。
