Impact on outcomes of STEMI from thrombotic coronary embolism origin

The multifactorial etiology of coronary embolism, a cause of nonatherosclerotic ST-elevation myocardial infarction, warrants different initial management strategies and outcomes. Our aim was to assess the clinical characteristics and outcomes in a specific population of patients presenting with thrombotic coronary emboli-related ST elevation myocardial infarction. Of 2374 consecutive patients with de novo ST elevation myocardial infarction initially identified, 6 with non-thrombotic coronary emboli were excluded, and the remaining 2368 patients were stratified into the thrombotic coronary emboli (CE group n = 116) and atherothrombotic cause (atherosclerosis group; n = 2252) groups. Compared with the atherosclerosis group, the coronary emboli group was more likely to include female patients (33% vs. 23%, p = 0.014) and cardiogenic shock was the initial clinical presentation in more than one-fifth of the cases in the coronary emboli group (21% vs. 10%, p < 0.001). The unadjusted analysis showed that, in CE group, compared to the atherosclerosis group, the mortality rate was consistently higher at the 45-day (10% vs. 4%, p = 0.004) and 2-year (14% vs. 7%, p = 0.018) follow-up, although this disappeared after stabilized Inverse Exposure Probability Weighting adjustment. In conclusion, thrombotic coronary emboli in patients with ST elevation myocardial infarction were, after adjustment, unassociated with higher mortality rates. The early excess mortality in this group was related to the initial clinical presentation and comorbidities. (ClinicalTrials.gov Identifier: NCT05679843).