Atrial Fibrillation Versus Nonatrial Fibrillation Coronary Embolism: A Multicenter Study

Coronary embolism (CE) is an underrecognized cause of acute myocardial infarction, and limited data exist comparing atrial fibrillation-related CE (AF CE) with CE from other causes.

We conducted the first multicenter study in this challenging setting (NCT06948240). We retrospectively included 489 patients diagnosed with CE across 10 hospitals. CE was diagnosed using Shibata criteria. Patients were classified into AF CE and non-AF CE groups.

A total of 241 patients (49%) had AF CE. Distinctive angiographic features were reported in patients with AF CE: less proximal coronary obstruction (34% versus 46%, P=0.04), lower percutaneous coronary intervention rates (34% versus 45%, P=0.03), more frequent initial thrombolysis in myocardial infarction 0 flow (85% versus 70%, P=0.01), and less final thrombolysis in myocardial infarction 3 flow (52% versus 76%, P<0.001). In-hospital composite outcome occurred in 44% of patients with AF CE versus 25% in patients without AF CE (P<0.001), including higher mortality (14% versus 6%, P=0.003), heart failure (24% versus 14%, P=0.002), and cardiogenic shock (14% versus 8%, P=0.048). Long-term adverse events were also more frequent in AF CE (45% versus 16%, P<0.001), with higher rates of stroke (9% versus 3% P=0.02), heart failure (15% versus 5%, P=0.002), and all-cause mortality (34% versus 11%, P<0.001). In multivariable models, AF CE was independently associated with worse in-hospital outcomes (odds ratio, 3.3 [95% CI, 1.4-8; P=0.007]) and long-term events (hazard ratio, 2.5 [95% CI, 1.2-5; P=0.01]).

AF-related CE is associated with distinct angiographic patterns and independently predicts poor outcomes, highlighting the need for refined and tailored strategies in AF CE.