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Myocardial infarction secondary to coronary embolism: aetiology, clinical characteristics, and prognosis
Maria Calvo-Barceló1, Èlia Rifé-Pardo1, Laia Milà1
1Acute Cardiac Care Unit, Cardiology Service, Vall d'Hebron University Hospital and Research Institute, P. Vall d'Hebron 119-129, Barcelona 08035, Spain.
Insights
Coronary embolism (CE) in myocardial infarction (MI) is often caused by atrial fibrillation. While CE patients experience more complications and in-hospital events, long-term mortality and recurrent thromboembolism are similar to non-embolic MI.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Coronary embolism (CE) is a rare cause of myocardial infarction (MI) with limited data on its characteristics and prognosis.
- Understanding the clinical spectrum of CE is crucial for improving patient outcomes.
Purpose of the Study:
- To describe the clinical features of embolic myocardial infarction (MI).
- To compare the characteristics and prognosis of CE-MI with non-embolic MI.
Main Methods:
- Retrospective review of all acute MI admissions from January 2010 to December 2023.
- Diagnosis of CE based on established criteria.
- Comparison of CE patients with non-CE MI patients, including propensity-matched analysis for long-term outcomes.
Main Results:
- CE accounted for 1.1% of acute MI cases (89/8160).
- Atrial fibrillation (AF) was the most common cause (52.8%), followed by prosthetic valve thrombosis and endocarditis.
- CE patients were more often female, had fewer cardiovascular risk factors, and presented more with ST-segment elevation MI (STEMI).
- CE was associated with higher rates of unsuccessful reperfusion, mechanical complications, and in-hospital strokes/transient ischemic attacks (TIAs).
- In-hospital mortality was not significantly different between CE and non-CE MI groups.
- Long-term follow-up showed no significant differences in overall mortality or recurrent thromboembolic events between groups, though CE survivors had more heart failure admissions.
Conclusions:
- Coronary embolism is primarily caused by atrial fibrillation and often presents as STEMI.
- CE is linked to increased mechanical complications and early embolic events but not recurrent thromboembolism post-discharge.
- Mortality rates are comparable between coronary embolism and non-embolic myocardial infarction.
Aims:
Limited data are available regarding aetiology, clinical characteristics, and prognosis of coronary embolism (CE). This study aimed to describe the clinical features of embolic myocardial infarction (MI) and compare them with non-embolic MI.
Methods And Results:
All admissions for acute MI in a single tertiary centre between January 2010 and December 2023 were reviewed. Coronary embolism was diagnosed by established criteria. Among 8160 patients, 89 (1.1%) were diagnosed with CE. The most common attributable cause was atrial fibrillation (AF) (52.8%), followed by prosthetic valve thrombosis (11.2%) and endocarditis (7.9%). Compared with the remaining patients, those with CE were more frequently female, had a lower prevalence of cardiovascular risk factors, and presented more often with ST-segment elevation (79.8 vs. 58.6%, P < 0.001). Coronary embolism patients had a high frequency of unsuccessful reperfusion and higher rates of mechanical complications (5.6 vs. 2.2%, P = 0.031) and strokes/transient ischaemic attacks (6.7 vs. 1.3%, P < 0.001) than those with non-CE MI, although in-hospital mortality was not statistically different (9.0 vs. 6.4%, respectively, P = 0.321). In a propensity-matched analysis among hospital survivors (77 in each group), no differences were observed over a median follow-up of 59.6 months in overall mortality or thrombo-embolic events after discharge, although more patients in the CE group were admitted for heart failure.
Conclusion:
Coronary embolism is mostly caused by AF, usually presents with ST-segment elevation, and is associated with higher rates of mechanical complications and in-hospital embolic events, but not of recurrent thromboembolism after discharge. No significant differences in mortality were observed between CE and non-CE MI.
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