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Proposed National Cerebral and Cardiovascular Center criteria for the clinical diagnosis of coronary artery embolism

Proposed National Cerebral and Cardiovascular Center criteria for the clinical diagnosis of coronary artery embolism
Major criteria
  • Angiographic evidence of coronary artery embolism and thrombosis without atherosclerotic components
  • Concomitant coronary artery embolization at multiple sites*
  • 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 MRI
  • 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 criteria, or
  • Three minor criteria
Probable CE
  • One major criterion plus one 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.
MRI: magnetic resonance imaging; CE: coronary artery embolism.
* Indicates multiple vessels within one coronary artery territory or multiple vessels in the coronary tree.
From: Shibata T, Kawakami S, Noguchi T, et al. Prevalence, clinical features, and prognosis of acute myocardial infarction attributable to coronary artery embolism. Circulation 2015; 132:241. DOI: 10.1161/CIRCULATIONAHA.114.015134. Copyright © 2015 American Heart Association. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.
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