Yesin M, et al. - In non-ST elevation acute coronary syndrome (NSTEACS) patients with prosthetic heart valves (mitral:27, aortic:14, mitral+aortic:7) and transthoracic and transesophageal echocardiographic (TEE) examination and coronary angiography, the diagnosis and treatment strategies for NSTEACS were investigated. The following favored coronary thromboembolism (CE) rather than atherothrombosis: normal coronary angiographic findings, or visible trombus in one of the coronary arteries, international normalized ratio < 2, concomitant prosthetic valve thrombosis (PVT) and absence of multivessel atherosclerotic disease. Findings demonstrated that in patients with prosthetic heart valves, an association of NSTEACS with PVT derived CE rather than atherosclerosis was more likely. In patients with CE and/or PVT, thrombolytic therapy (TT) with low-dose slow infusion of tissue type plasminogen activator (tPA) was found to be efficacious as well as safe.