Coronary embolism, an infrequent cause of acute coronary syndrome. A case serie

Type of funding sources: None.

Coronary embolism (CE) is a heterogeneous and infrequent aetiology of acute coronary syndrome (ACS), with current evidence from small case series and with an angiographic and etiological diagnostic challenge.

Our work evaluated baseline characteristics and in-hospital management and prognostic of patients with CE.

Observational, retrospective descriptive study of patients admitted in our unit from July 2011 to February 2020 for ACS and diagnosed with CE (National Cerebral Cardiovascular Center Criteria). 

In this period, there were 2745 patients admitted because of ACS. Out of them, 36 patients had criteria of CE (1.3%, 95% confidence interval 0.9 to 1.8%). The mean age was 71 ± 13 years, 75% were women and 25% men. Most patients (66.7%) presented with STEMI. There was a history of hypertension in 80.6%, hyperlipidaemia in 47.2%, diabetes mellitus in 30.6%, active smoking in 19.4%, and  30.6% of atrial fibrillation (AF). Among patients with previous AF, 54.5% had no previous antithrombotic treatment. 77.1% do not have thromboembolic risk factors.

The most frequent aetiology was AF (47.2%, 11.8% de novo), with unknown aetiology in second place (33.3%). Two cases were caused by thrombophilia (5.6%), three cases associated with left prosthetic valves (8.3%), one septic emboli (2.8%) and one caused by left ventricular thrombus (2.8%).

The anterior descending artery was the most affected vessel (52.8%) and the treatment was stenting in 33.3%, isolated thrombus aspiration in 22.2%, and medical management in 33,3% of patients. At discharge, most of patients were under antiplatelet and anticoagulant combination therapy (61.1%), and 5.6% only with anticoagulant treatment. In our serie, in-hospital mortality was 8.4% (one cardiac arrest as clinical presentation).

CE is a relevant entity due to its clinical considerations, more frequent in women and with AF as main risk factor. One third of patients are of unknown aetiology. Currently therapeutic management is based on interventional cardiologist criteria. To date, there is still lacking a standardized diagnostic criteria and validated management guidelines.