Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Due to Coronary Artery Embolism
Background—Coronary artery embolism (CE) is recognized as an important non-atherosclerotic cause of acute myocardial infarction (AMI). Its prevalence, clinical features, and prognosis remain insufficiently characterized.
Methods and Results—We screened 1,776 consecutive patients who presented with de novo AMI between 2001 and 2013. CE was diagnosed based on criteria encompassing histological, angiographical, and other diagnostic imaging findings. The prevalence, clinical characteristics, treatment strategies, in-hospital outcomes, and long-term risk of CE recurrence or major adverse cardiac and cerebrovascular events (MACCE: cardiac death, fatal arrhythmia, or recurrent thromboembolism) were evaluated. The prevalence of CE was 2.9% (n=52), including 8 (15%) patients with multi-vessel CE. Atrial fibrillation (AF) was the most common cause (n=38, 73%). Only 39% of patients with CE were treated with vitamin K antagonists, and the median international normalized ratio was 1.42 (range, 0.95-1.80). Eighteen of the thirty CE patients with non-valvular AF had a CHADS2 score of 0 or 1. When those patients were re-evaluated using CHA2DS2-VASc, 61% were reassigned to a higher risk category. During a median follow-up of 49 months, CE and thromboembolism recurred in 5 AF patients. The five-year rate of MACCE was 27.1%. In the propensity score-matched cohorts (n=45 each), Kaplan-Meier analysis showed a significantly higher incidence of cardiac death in the CE group compared to the non-CE group (hazard ratio, 9.29; 95% confidence interval, 1.13-76.5; p<0.001).
Conclusions—AF is the most frequent cause of CE. Patients with CE represent a high-risk subgroup of AMI patients and require close follow-up.
- coronary artery embolism
- coronary artery
- acute myocardial infarction
- atrial fibrillation
- Received December 25, 2014.
- Revision received April 20, 2015.
- Accepted May 15, 2015.