Long-term outcomes in atrial fibrillation coronary embolism: a multicenter study

Q: What are the key findings of this study?

Atrial fibrillation in patients with coronary embolism was independently associated with a higher risk of adverse long-term outcomes (OR 2; 95% CI 1.04-4; p=0.04).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary embolism (n=165). Intervention: Atrial fibrillation vs. No atrial fibrillation. Primary outcome: Composite of reinfarction, stroke, cardiovascular mortality, all-cause mortality, and heart failure during follow-up (OR 2, 95% CI 1.04-4, p=0.04).

Q: What does this research mean for the field?

Atrial fibrillation coronary embolism patients have double the risk of poor long-term outcomes compared to non-AF patients (OR 2, 95% CI 1.04-4, p=0.04). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

A Lanaspa Gallego; A Vera Sainz; C Jimenez Mendez; R Alvarez Velasco; O Jimenez Melo; A Navarro Echeverria; M Basurte Elorz; M Beunza Pujol; M Ciriza Esandi; N Basterra Sola; R Sadaba Sagredo; V Ruiz Quevedo; J Ugarriza Ortueta; J Garcia Ugaldebere; V Alvarez Asiain

doi:10.1093/eurheartj/ehaf784.2161

November 1, 2025European Heart Journal

Long-term outcomes in atrial fibrillation coronary embolism: a multicenter study

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Key result

AF-related coronary embolism linked to ~100% higher risk of adverse long-term outcomes versus non-AF CE.

OR 2
95% CI 1.04-4
P=0.04
n=165

Why the study?

Evidence on the long-term prognosis of coronary embolism due to AF is scarce and based on small unicentric retrospective studies.

Does the presence of atrial fibrillation worsen long-term outcomes in patients with coronary embolism?

Key Points

This study investigates the long-term outcomes of coronary embolism associated with atrial fibrillation compared to non-atrial fibrillation cases.
Conducted a multicenter study involving three hospitals.
Compared patients with coronary embolism with and without atrial fibrillation.
Defined embolism according to Shibata criteria.
Analyzed primary endpoint of composite adverse events during follow-up.
Found that AF-CE patients were older and had higher rates of comorbidities.
During follow-up, AF-CE patients experienced significantly higher event rates including strokes, heart failure, and cardiovascular deaths.
Multivariate analysis identified AF-CE as an independent predictor of worse outcomes.

Study Design

Type

Cohort (n=165)

Multicenter

Yes

Structured PICO

Does the presence of atrial fibrillation worsen long-term outcomes in patients with coronary embolism?

P

Population

165 patients with coronary embolism (81 with atrial fibrillation and 84 without) evaluated for long-term outcomes.

E

Exposure

Presence of atrial fibrillation (AF-CE)

C

Comparator

Absence of atrial fibrillation (non-AF CE)

O

Outcome

Composite of reinfarction, stroke, cardiovascular mortality, all-cause mortality, and heart failure during follow-upcomposite

Main Result

Odds Ratio: 2 (95% CI 1.04–4)

p-value: p=0.04

Atrial fibrillation is an independent predictor of worse long-term outcomes in patients with coronary embolism, highlighting the need for targeted secondary prevention.

Implication

AF-CE was associated with doubled adjusted long-term risk; leaves open whether intensified secondary prevention improves outcomes.

Abstract

Background Coronary embolism (CE) is an uncommon cause of acute coronary syndrome, with atrial fibrillation (AF) being the most frequent etiology. However, evidence on the long-term prognosis of CE due to AF is scarce and based on small unicentric retrospective studies. Methods We conducted a multicenter study across three hospitals, comparing CE patients with and without AF. CE embolism was defined according to Shibata criteria. The primary endpoint was a composite of reinfarction, stroke, cardiovascular mortality, all-cause mortality, and heart failure during follow-up. Results A total of 165 patients with CE were included (81 AF-CE, 84 non-AF CE). AF-CE patients were older (76±11 vs. 60±15 years, p<0.001) and had higher rates of hypertension (63% vs. 39%, p=0.002), diabetes (22% vs. 11%, p=0.046), chronic kidney disease (19% vs. 4%, p=0.002), and previous stroke (16% vs. 4%, p=0.01). They also had a lower presentation as MINOCA (25% vs. 54%, p<0.001), lower LVEF (51±13 vs. 56±11, p=0.01), higher in-hospital Heart failure (24% vs. 12%, p=0.02) and higher in-hospital mortality (17% vs. 5%, p=0.02). There was no difference among groups regarding invasive management. During follow-up, 43 events were recorded: 11 strokes, 13 heart failure episodes, 8 reinfarctions, 9 cardiovascular deaths, 3 thromboembolic events, and 22 all-cause deaths, with 23 patients experiencing multiple events. Kaplan-Meier analysis showed a significantly higher event rate in AF-CE patients (log-rank p=0.01) (Figure 1). After adjusting for potential confounders, multivariate analysis showed that AF-CE (OR 2, 95% CI 1.04-4, p=0.04) and STEMI presentation (OR 2.4, 95% CI 1.4-6, p=0.005) were independent predictors of worse outcomes. Conclusion AF CE is associated with worse long-term outcomes, highlighting the need for targeted secondary prevention strategies in this high-risk population. Kaplan-Meier Survival curve

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Cite This Study

Gallego et al. (2025) conducted a cohort in Coronary embolism (n=165). Atrial fibrillation vs. No atrial fibrillation was evaluated on Composite of reinfarction, stroke, cardiovascular mortality, all-cause mortality, and heart failure during follow-up (OR 2, 95% CI 1.04-4, p=0.04). Atrial fibrillation in patients with coronary embolism was independently associated with a higher risk of adverse long-term outcomes (OR 2; 95% CI 1.04-4; p=0.04).

synapsesocial.com/papers/698585bd8f7c464f23009515 https://doi.org/10.1093/eurheartj/ehaf784.2161