Coronary Artery Embolism - Etiology and Scoring

Etiology:

 • Direct: Clot (LV thrombus, LAA Thrombus), Valve (Vegetation, Thrombus, Fibroelastoma), Mass (Myxoma, Rhabdomyosarcoma)

 • Paradoxical: Right to Left from Venous System/Right Heart, Via PFO or Interatrial Shunt

 • Iatrogenic: s/p Coronary Angiography or Cardiac Surgery - Most Common Cause

Scoring:

Major:

 • Angiographic evidence of coronary embolus (CE) w/o significant atherosclerosis

 • Concomitant coronary emboli in multiple coronary vascular territories

 • Concomitant systemic embolization Wlo LV thrombus attributable to acute MI

 • Histologic evidence of venous origin of CE material

 • Evidence of an embolic source based on TTE, TEE, CT or MRI

Minor:

 • < 25% stenosis on coronary angiography in the non-culprit vessels

 • Atrial Fibrillation

 • Presence of embolic risk factors: cardiomyopathy, rheumatic valve disease, prosthetic valve, PFO, ASD, h/o of cardiac surgery, endocarditis or hypercoaguable state

Scoring:

 • Definite: (>2 Major Criteria) OR (1 Major + ≥ 2 Minor) OR (3 Minor)

 • Probable: (1 Major + 1 Minor Criteria) OR (2 minor)



- Cardionerds - Karan Desai MD, MPH @karanpdesai



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