Atrial Fibrillation Versus Nonatrial Fibrillation Coronary Embolism: A Multicenter Study.

Area of Science:

• Cardiology
• Vascular Medicine
• Interventional Cardiology

Background:

• Coronary embolism (CE) is an underrecognized cause of acute myocardial infarction.
• Limited data exist comparing CE related to atrial fibrillation (AF CE) with CE from other causes.

Purpose of the Study:

• To compare the clinical characteristics, angiographic features, and outcomes of patients with AF CE versus non-AF CE.
• To identify distinct patterns and prognostic implications of AF CE.

Main Methods:

• A multicenter retrospective study including 489 patients diagnosed with CE.
• Patients were classified into AF CE and non-AF CE groups based on Shibata criteria.
• Analysis of angiographic features, percutaneous coronary intervention rates, and in-hospital and long-term adverse events.

Main Results:

• AF CE patients (49%) showed less proximal obstruction, lower PCI rates, and more initial TIMI 0 flow.
• In-hospital outcomes were worse in AF CE (44% vs. 25%), including higher mortality, heart failure, and cardiogenic shock.
• Long-term events were also more frequent in AF CE (45% vs. 16%), with increased stroke, heart failure, and mortality rates.
• AF CE independently predicted worse in-hospital (OR 3.3) and long-term outcomes (HR 2.5).

Conclusions:

• AF-related CE is associated with distinct angiographic patterns.
• AF CE independently predicts poor in-hospital and long-term outcomes.
• Refined and tailored management strategies are necessary for AF CE.