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Published on: May 28, 2019
Coronary Embolism Among ST-Segment-Elevation Myocardial Infarction Patients: Mechanisms and Management
Batric Popovic1, Nelly Agrinier2, Nidhal Bouchahda2
1From the Département de Cardiologie (B.P., N.B., S.P., C.H.M., P.A.M., C.S.S., Y.J., E.C.) and Epidémiologie et Evaluation Cliniques (N.A.), CHU Nancy, France. b.popovic@chu-nancy.fr.
Insights
Coronary artery embolism (CE) is a significant cause of ST-elevation myocardial infarction, often linked to diverse cardiac and systemic conditions. Patients with CE face a substantially higher risk of mortality compared to those without.
Area of Science:
- Cardiology
- Vascular Medicine
- Internal Medicine
Background:
- Coronary artery embolism (CE) is a key nonatherosclerotic cause of ST-segment-elevation myocardial infarction (STEMI).
- Understanding the clinical profile and outcomes of CE in STEMI patients is crucial for improved management.
Purpose of the Study:
- To delineate the clinical characteristics of STEMI patients with CE.
- To evaluate long-term outcomes in CE patients.
- To identify risk factors associated with CE in STEMI.
Main Methods:
- A cohort of 1232 consecutive STEMI patients was analyzed.
- CE diagnosis was based on integrated clinical, angiographic, and imaging data.
- Comparison between CE and non-CE groups identified distinct features and outcomes.
Main Results:
- Fifty-three patients (4.3%) were diagnosed with CE, with some having multisite or extracoronary involvement.
- CE patients showed higher rates of smoking and elevated BMI, but similar age and traditional risk factors compared to non-CE.
- Common underlying conditions included atrial fibrillation, dilated cardiomyopathy, malignancy, and autoimmune diseases; 26.4% had unidentified causes.
- Interventional procedures differed, with more glycoprotein IIb/IIIa inhibitor use and less angioplasty in the CE group.
Conclusions:
- STEMI secondary to CE has varied etiologies, stemming from both cardiac and systemic diseases.
- CE is associated with significantly worse long-term survival than anticipated based on baseline cardiovascular risk.
- Further research into the diverse etiopathogenesis of CE is warranted.
Background:
Coronary artery embolism (CE) is recognized as an important nonatherosclerotic cause of ST-segment-elevation myocardial infarction. The objective was to describe clinical characteristics and long-term outcomes and to identify risks factors of CE in a large consecutive series of ST-segment-elevation myocardial infarction patients.
Methods And Results:
We studied 1232 consecutive patients who presented with de novo ST-segment-elevation myocardial infarction. CE was diagnosed based on criteria encompassing clinical, angiographic, and diagnostic imaging findings. A total of 53 patients were identified in the CE group including 12 (22.6%) patients with multisites CE and 9 patients with other extracoronary localization. Compared with the non-CE group, age and coronary risks factors were not significantly different in the CE group except for smoking (P=0.03) and body mass index (P<0.001). Interventional coronary procedures were characterized by a higher use of glycoprotein IIb/IIIa inhibitors (P<0.001) and lower use of angioplasty (P<0.001) in the CE group. The most frequent underlying cardiac diseases were atrial fibrillation (n=15, 28.3%) followed by dilated cardiomyopathy (n=5), endocarditis (n=4), and intracardiac tumor (n=3), whereas among systemic diseases, malignancy (n=8) and systemic autoimmune disease or antiphospholipid syndrome (n=4) were present. No etiopathological mechanisms could be identified in 14 patients (26.4%). Coronary embolism was associated with a higher risk of death (crude hazard ratio, 4.87; 95% confidence interval, 2.52-9.39; P<0.0001).
Conclusions:
Etiopathogenesis of ST-segment-elevation myocardial infarction secondary to CE is diverse ranging from cardiac to systemic disease, and patient long-term survival is worse than expected according to the baseline cardiovascular risk.
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