Microvascular Coronary Artery Embolism Presenting as an OHCA STEMI Call Detected by CMRI.

We describe a case of coronary artery embolism leading to an out-of-hospital cardiac arrest (OHCA) in which the diagnosis was achieved with utilisation of cardiac magnetic resonance imaging. The patient was otherwise well prior to this episode. Emergency diagnostic coronary angiography revealed patent arteries with TIMI 3 flow. Subsequent cardiac magnetic resonance imaging demonstrated myocardial infarction and focal microvascular obstruction in the infarcted territory. This report describes an uncommon case presentation, highlights areas for improvement in diagnostic criteria, and briefly discusses the currently available data regarding coronary artery embolism. LEARNING POINTS: Coronary artery embolism is uncommon but it is important to accurately diagnose it given the associated poor prognosis.Currently proposed scoring systems for the diagnosis of coronary artery embolism do not include the use of cardiac magnetic resonance imaging to identify intra-coronary emboli.Consideration should be given to including cardiac magnetic resonance imaging for the detection of intra-coronary emboli as an alternative to angiography in scoring criteria used to diagnose coronary artery embolism. © EFIM 2020.