Acute Coronary Syndrome (ACS) due to Coronary Artery Embolism in a Patient with Atrial Fibrillation
Table 2
Proposed National Cerebral and Cardiovascular Center (NCVC) criteria for the clinical diagnosis of coronary artery embolism (CE) [1].
Major criteria
Angiographic evidence of CE and thrombosis without atherosclerotic components
Concomitant coronary artery embolization at multiple sitesa
Concomitant systemic embolization without left ventricular thrombus attributable to acute myocardial infarction
Minor criteria
<25% stenosis on coronary angiography, except for the culprit lesion
Evidence of an embolic source based on transthoracic echocardiography transesophageal echocardiography, computed tomography, or magnetic resonance imaging
Presence of embolic risk factors: atrial fibrillation, cardiomyopathy, rheumatic valve disease, prosthetic heart valve, patent foramen ovale, atrial septal defect, history of cardiac surgery, infective endocarditis, or hypercoagulable state
Definite CE
Two or more major criteria, or
One major criterion plus ≥ 2 minor criterion, or
Three minor criteria
Probable CE
One major criterion plus 1 minor criterion, or
Two minor criteria
A diagnosis of CE should not be made if there is
Pathological evidence of atherosclerotic thrombus
History of coronary revascularization
Coronary artery ectasia
Plaque disruption or erosion detected by intravascular ultrasound or optic coherence tomography in the proximal part of the culprit lesion
The present proposed diagnostic criteria for CE include three major and three minor criteria. Weighted scoring of the criteria is used to differentiate between definite and probable CE in patients with acute myocardial infarction. aMultiple vessel within one coronary artery territory or multiple vessels in the coronary tree. Note: this table is reproduced from Nakano H, Yamagami H, Ofuchi H. A case report of systemic embolic events associated with atrial fibrillation. Acute Medicine & Surgery 2017;4:12730.doi:10.1002/ams2.235.
