Approaches to diagnosis and treatment of thromboembolic variant of myocardial infarction

Authors: Shmidt E.A., Zhidkova I.I.

Company: Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation

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Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2022-16-4-431-442

For citation: Shmidt E.A., Zhidkova I.I. Approaches to diagnosis and treatment of thromboembolic variant of myocardial infarction. Creative Cardiology. 2022; 16 (4): 431–42 (in Russ.). DOI: 10.24022/1997-3187-2022-16-4-431-442

Received / Accepted:  12.10.2022 / 14.12.2022

Keywords: embolic myocardial infarction coronary arteries myocardial infarction with nonobstructive coronary arteries

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Abstract

Currently, there are no unified evidence-based recommendations on the diagnosis and treatment of coronary embolism. This article presents world literature data on current causes of development, clinical course, diagnosis and treatment of acute embolic myocardial infarction (MI). In 73% of cases of embolic MI, the most common etiology of coronary embolism, in addition to the presence of prosthetic heart valves; cardiomyopathies; stenosis of the aortic and mitral valves; oncopathologists; is atrial fibrillation. Difficulties in the clinical diagnosis of coronary embolism are associated with: the presence of thromboembolism, usually located distally in usually intact coronary arteries (CA) leading to transmural MI; with the possibility of recanalization of the embolus (in this case, the development of MI occurs in areas supplied with angiographically normal CA); subclinical manifestation of the disease. The dimensions of the embolus, the features of the anatomy of the patient's coronary bed, and the localization of coronary artery occlusion determine the clinical manifestations of coronary embolism. The frequency of complete restoration of blood flow in case of AK embolism is about 65%.

The need for emergency reperfusion in coronary embolism forces us to look for new approaches to the endovascular treatment of this pathology. One of the most effective methods is percutaneous coronary intervention with recanalization and stenting of the symptomatic artery using reperfusion of the embolized CA by thrombus aspiration or intracoronary thrombolysis. A promising direction in the treatment of embolic MI may be the use of stentrivers for transcatheter extraction of blood clots from cerebral arteries. It is important to timely identify risk factors and the presence of diseases that caused embolic MI; prescribe treatment for the underlying disease. Anticoagulant therapy is the standard of care for embolic MI.

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About Authors

  • Еvgeniya A. Shmidt, Dr. Med. Sci., Associate Professor, Leading Researcher; ORCID
  • Irina I. Zhidkova, Cand. Med. Sci., Researcher; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery