Antithrombotic Therapy in Coronary Embolism: A Multicenter Study

Background Coronary embolism (CE) is an uncommon cause of acute myocardial infarction, and the optimal post-discharge antithrombotic strategy remains uncertain. Methods Retrospective multicenter study including patients with definite or probable CE. Three groups of patients were identified: i) requiring with specific management, ii) with atrial fibrillation (AF), and iii) with no indication for oral anticoagulation (OAC). The latter two groups were further classified according to the antithrombotic treatment received, and long-term outcomes (composite of recurrent CE, stroke, systemic embolism, cardiovascular or all cause death and major bleeding at 5 years) were subsequently evaluated Results A total of 489 patients were considered. Among 189 patients with AF, 85 received direct oral anticoagulants (DOAC) and 104 vitamin K antagonists (VKAs). VKA users showed a higher rate of the composite endpoint compared with DOACs (40% vs. 18%, p < 0.001) with the difference primarily driven by all-cause mortality. In multivariable analysis, VKA therapy remained independently associated with worse outcomes (HR 1.9, 95% CI 1.02-3.5; p=0.04). In the 182 patients without an indication for anticoagulation, 115 received antiplatelet therapy and 67 OAC. Those treated with OAC had a higher incidence of the composite outcome (16% vs. 7%, p=0.049) with the difference primarily driven by all-cause mortality. Multivariable analysis confirmed OAC as an independent predictor of adverse prognosis (HR 3.4 (95%CI 1.2-9.7;p=0.02). Conclusions In patients with CE, stratification based on underlying etiology and embolic risk before hospital discharge might serve as a decision-making approach for determining optimal antithrombotic strategies and improved clinical outcomes.