Coronary Embolism Among ST-Segment–Elevation Myocardial Infarction Patients

Popovic, Batric; Agrinier, Nelly; Bouchahda, Nidhal; Pinelli, Samuel; Maigrat, C.H.; Metzdorf, Pierre Adrien; Selton-Suty, Christine; Juillière, Yves; Camenzind, Edoardo

doi:10.1161/circinterventions.117.005587

Cited by 79 publications

(72 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our further work-up was aimed at finding a causative link for the coronary embolism. Literature search showed the most common factors leading to coronary emboli in the order of descending significance to be (a) atrial fibrillation, (b) dilated cardiomyopathy, (c) endocarditis, and (d) intra-cardiac tumors [3]. Other systemic prothrombotic diseases like active malignancies or systemic autoimmune diseases are also found to be responsible for coronary embolism.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Coronary Embolism and Myocardial Infarction in a Transgender Male Undergoing Hormone Therapy: A Case Report and Review of the Literature

Dinesh

Franz

Küthe³

2020

Case Reports in Cardiology

View full text Add to dashboard Cite

Introduction. Due to the complex interaction between the underlying disease, psychosocial factors, and the high-dose hormonal therapy, transgender patients pose a therapeutic and diagnostic challenge, especially during emergencies. This case presents one such clinical dilemma using the example of a case of myocardial infarction. Case. A 35-year-old transgender male presented to our clinic with an acute inferior wall myocardial infarction. For the past 6 years, he was receiving high-dose testosterone therapy for the maintenance of hormone levels after female-to-male gender conversion. The emergency coronary angiography revealed a distal right coronary artery occlusion. Recanalization of the vessel was achieved by catheter-driven direct thrombectomy and subsequent intracardiac lysis. The appearance of the remaining coronary arteries bore no angiographic evidence of advanced coronary artery disease. We suspected a thromboembolic origin as the primary cause of the myocardial infarction. The presentation also fulfilled the proposed National Cerebral and Cardiovascular Center criteria for the clinical diagnosis of coronary embolism. In the diagnostic work-up, the most common causes of coronary embolism like atrial fibrillation, cardiomyopathies, endocarditis, and intracardiac tumors could be ruled out. The screening for hereditary thrombophilia was also negative. Likewise, the presence of a haemodynamically relevant right to left shunt could be excluded. In the end, the high-dose testosterone therapy seemed to be the most likely cause. Conclusion. Following major thromboembolic cardiovascular events, we believe that transgender males treated with high-dose testosterone therapy should receive oral anticoagulation, preferably with a DOAC, especially keeping in mind that the discontinuation of the hormone therapy is not always possible due to the various underlying psychosocial factors.

show abstract

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Coronary Embolism and Myocardial Infarction in a Transgender Male Undergoing Hormone Therapy: A Case Report and Review of the Literature

Dinesh

Franz

Küthe³

2020

Case Reports in Cardiology

View full text Add to dashboard Cite

show abstract

“…These patients were not young but had no evidence of coronary atherosclerosis. 45 In the Young Adult Myocardial Infarction and Ischemic Stroke (YAMIS) Study, major venoarterial shunt was found in 25% of 101 young patients (16-39 years) who survived an MI and stroke. 46 Paradoxical embolism as the cause should be considered in young adults in the presence of additional hypercoagulable risk factors (pregnancy, ischemic stroke, factor V Leiden).…”

Section: Framingham Datamentioning

confidence: 99%

Acute Myocardial Infarction in Young Individuals

Gulati

Behfar

Narula

et al. 2020

Mayo Clinic Proceedings

234

156

View full text Add to dashboard Cite

Globally, cardiovascular disease remains a major cause of adverse outcomes in young individuals, unlike its decline in other age groups. This group is not well studied and has a unique risk profile with less traditional cardiovascular risk factors compared with older populations. Plaque rupture still remains the most common etiology of myocardial infarction, but unique syndromes such as plaque erosion, coronary microvascular dysfunction, spontaneous coronary artery dissection, and coronary spasm related to drug use are more prevalent in this age group. Such diversity of diagnosis and presentation, along with therapeutic implications, underscore the need to study the profile of myocardial infarction in young persons. We searched PubMed for articles published from 1980 to 218 using the terms acute myocardial infarction, young, plaque rupture, plaque erosion, spontaneous coronary artery dissection (SCAD), coronary vasospasm, variant or Prinzmetal angina, drug-induced myocardial infarction, myocarditis, coronary embolism, microvascular dysfunction, MINOCA, and myocardial infarction in pregnancy and reviewed all the published studies. With the data from this search, we aim to inform readers of the prevalence, risk factors, presentation, and management of acute myocardial infarction in young patients and elaborate on special subgroups with diagnostic and therapeutic challenges. We also outline a parsimonious method designed to simplify management of these complex patients.

show abstract

“…However, recognition of CE, in addition to specific medical management, is important because of the need for closer monitoring in this subpopulation and increased risk of cardiac death as compared with the patients with atherosclerotic myocardial infarction. 3 Patients with CE myocardial infarction suffer from significantly increased 5-year risk of adverse cardiac and cerebrovascular events, which may be as high as 27%. 2 Age greater than 60 years, female gender, reduced left ventricular ejection fraction and atrial fibrillation are independent risk factors for major adverse cardiovascular events in patients with non-atherosclerotic myocardial infarction, 4 emphasising the importance of recognising CE and associated prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

Paroxysmal atrial fibrillation presenting as anterior wall STEMI in an elderly woman

Shabbir

Shaukat²,

Sullenberger

et al. 2019

BMJ Case Rep

View full text Add to dashboard Cite

A 77-year-old woman without traditional risk factors for coronary artery disease (CAD) underwent coronary CT-angiography for evaluation of palpitations after negative Holter monitoring and non-diagnostic ECG exercise stress test. Coronary artery calcium score was reported zero; 1 day later, she was admitted with anterior-wall ST elevation myocardial infarction. Acute left anterior descending artery thrombus was treated with mechanical thrombectomy and Percutaneous Coronary Intervention (PCI). Interestingly, the coronary arteries were angiographically normal. During hospitalisation, paroxysmal atrial fibrillation was noted followed by initiation of anticoagulation. Echocardiogram did not show thrombus or atrial shunt. Cardioversion with Sotalol was successful. Myocardial infraction was most likely cardioembolic secondary to paroxysmal atrial fibrillation—consistent with longstanding history of palpitations. Accounting for 3% of acute coronary syndromes, coronary embolism is treated with therapeutic anticoagulation for at least 3 months irrespective of cause and carries a higher risk of adverse cardiovascular events.

show abstract

Coronary Embolism Among ST-Segment–Elevation Myocardial Infarction Patients

Abstract: Etiopathogenesis of ST-segment-elevation myocardial infarction secondary to CE is diverse ranging from cardiac to systemic disease, and patient long-term survival is worse than expected according to the baseline cardiovascular risk.

Cited by 79 publications

References 27 publications

Coronary Embolism and Myocardial Infarction in a Transgender Male Undergoing Hormone Therapy: A Case Report and Review of the Literature

Coronary Embolism and Myocardial Infarction in a Transgender Male Undergoing Hormone Therapy: A Case Report and Review of the Literature

Acute Myocardial Infarction in Young Individuals

Paroxysmal atrial fibrillation presenting as anterior wall STEMI in an elderly woman

Contact Info

Product

Resources

About