Key result
Suspected coronary embolism from paroxysmal AF triggers inferolateral STEMI via complete branch occlusion.
Why the study?
Coronary embolism is an underrecognized nonatherosclerotic cause of STEMI, commonly associated with atrial fibrillation, posing diagnostic challenges.
Case Report (n=1)
No
This case highlights the diagnostic challenges of suspected coronary embolism in STEMI patients with atrial fibrillation and minimal underlying coronary artery disease, demonstrating that conservative medical management can be effective when distal revascularization fails.
May prompt consideration of embolism in AF-related STEMI; leaves open prospective validation of Shibata criteria.
Coronary embolism is an underrecognized nonatherosclerotic cause of ST-segment elevation myocardial infarction (STEMI), most commonly associated with atrial fibrillation. We report a 76-year-old man with paroxysmal atrial fibrillation who presented with acute substernal chest pain and inferolateral STEMI. Coronary angiography demonstrated a 100% thrombotic occlusion of the distal right posterolateral ventricular branch with otherwise nonobstructive coronary artery disease. In the setting of an abrupt distal coronary occlusion, minimal underlying atherosclerotic disease, paroxysmal atrial fibrillation, and fulfillment of the Shibata diagnostic criteria, coronary embolism was considered the most likely mechanism. Long-term anticoagulation was continued, and the patient remained asymptomatic at 1-month follow-up. This case highlights the diagnostic challenge of suspected coronary embolism in patients presenting with STEMI, atrial fibrillation, and minimal underlying coronary artery disease.
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Gopannagari et al. (2026) conducted a case report in ST-segment elevation myocardial infarction (STEMI) (n=1). Coronary embolism was evaluated. Suspected coronary embolism resulted in an inferolateral STEMI and 100% thrombotic occlusion of the distal right posterolateral ventricular branch in a patient with paroxysmal atrial fibrillation.
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