Abstract 16112: Clinical Impact of Acute Coronary Syndrome Due to Coronary Thromboembolism With Atrial Fibrillation
Introduction: Atrial fibrillation (AF) is a common entity and can be associated with thromboembolic complications, including the coronaryembolism. Generally, 4 to 7% of all patients diagnosed with acute myocardial infarction do not have atherosclerotic coronary disease at autopsy. However, the outcome of ST-elevation myocardial infarction (STEMI) due to coronary thromboembolism is still unknown. To clarify the impact of coronary thromboembolism, we compared the clinical features of STEMI patients with and without coronary thromboembolism.
Methods and Results: We enrolled STEMI patients who were diagnosed with coronary angiography. Patients were divided into two groups based on the presence or absence of coronary thromboembolism. Coronary embolism due to AF was diagnosed by 2 or more interventional cardiologist according to recorded AF at least once with electrocardiogram, globular filling defect at the occlusion site of coronary angiography, and/or coagulated thrombus with coronary aspiration procedure. Control groups were 90 STEMI patients with coronary atherosclerosis diagnosed by angiography. The primary endpoint was 30-day mortality. A total of 33 consecutive patients diagnosed acute coronary thromboembolism between January 2004 and April 2013. Baseline characteristics and outcomes of the study patients were summarized in the table. The patients in the embolization groups were elder and had lower prevalence of prodromal angina, had lower rate of performance of primary PCI, and were associated with higher 30-day mortality than that in the control group. Among 33 patients with embolism, 18 patients (56.2%) underwent transesophageal echocardiography.
Conclusions: STEMI due to coronary thromboembolism with atrial fibrillation has worse prognosis than STEMI with coronary atherosclerosis. A lack of preconditioning and may have micro shower embolism might increase adverse outcomes.
- © 2013 by American Heart Association, Inc.