049: Coronary artery embolism

Introduction Coronary artery embolism (CAE) is a rare cause of acute myocardial infarction (AMI). The prevalence of this entity remains unknown because of its difficult diagnosis in the acute setting. Purpose To study the etiologies, angiogram findings and the treatment of CAE. Methods Retrospective analysis between 2006 and 2011 year of 6 patients diagnosed with CAE in the departement of cardiology, Habib Thameur hospital. Results We report the observations of 6 patients with AMI managed in our cardiology departement. They were 2 men and 4 women, with mean age of 52.5 years, in whom CAE had been identified as final etiology for the AMI. All patients had no risk factors for coronary artery disease. Past medical history included rheumatic mitral stenosis in all cases and mitral valve replacement in 4 patients. The electrocardiogram revealed atrial fibrillation in 5 cases, complete left bundle branch block in 2 patients and ST segment elevation in the inferior leads in 4 cases. The mean INR level of patients was 1.8 on emergency admission. All patients had received immediately medical treatment including aspirin, clopidogrel and. Thrombolysis had been performed in 3 cases. Three patients underwent cardiac catheterization within 90 minutes of arrival. The coronary angiography was normal in 3 cases and showed a total occlusion of the right coronary artery in 1 case and a total occlusion of distal left anterior descending artery with intra luminal defect in the remaining cases. Aspiration catheter was used in 3 cases. Balloon angioplasty was performed only in 1 case. Transthoracic echocardiographic examination and transesophageal echocardiographic study demonstrated normal valvular function in all patients and signs of thrombus on the valves or in the cardiac chambers in 5 cases. All patients had a favorable outcome. Conclusion In individuals presenting with AMI, CAE should be kept in mind in those with atrial fibrillation or prosthetic valves even in the absence of classical coronary risk factors. Angioplasty using aspiration catheter may be an effective treatment of this condition. The outcome looks gratifying.