Key result
Coronary artery embolism in AMI is linked to ~95% higher four-year mortality versus non-CE AMI.
Why the study?
The prevalence, clinical features, and long-term outcomes of acute myocardial infarction due to coronary artery embolism remain unclear due to diagnostic difficulties in acute settings.
Does acute myocardial infarction due to coronary artery embolism have worse long-term outcomes compared to non-embolic AMI in patients undergoing coronary intervention?
Cohort (n=2,695)
Does acute myocardial infarction due to coronary artery embolism have worse long-term outcomes compared to non-embolic AMI in patients undergoing coronary intervention?
Absolute Event Rate: 28.8% vs 14.8%
p-value: p=0.03
AMI due to coronary artery embolism is rare (2.0%) but associated with higher all-cause mortality compared to non-embolic AMI, often occurring in older females with atrial fibrillation.
Background Coronary artery embolism (CE) is one of the important causes of acute coronary syndrome (ACS). The feature of CE is that angiographic evidence of coronary artery embolism and thrombosis without atherosclerotic components. However, the prevalence of CE remains unknown because of the diffifulty to diagnose in the acute settings. A recent retrospective analysis suggested that up to 3% of ACS cases may result from CE. Purpose The aim of this study was to elucidate the prevalence, clinical features and long-term outcomes including all-cause and cardiac death. Methods We analysed the consecutive 2695 patients with first AMI performed coronary intervention between January 2004 and July 2017. CE was diagnosed by clinical histories and angiographic findings. We retrospectively evaluated the clinical and lesion characteristics and outcomes including all-cause and cardiac death. Results The prevalence of CE was 2.0% (n=55; CE group and n=2640; non-CE group), including 8 (15%) patients with multivessel CE. The CE group had higher average age (70.8±14.9 vs. 68.4±12.6, p<0.01), prevalence of female (54% vs. 27%, p<0.01), lower prevalence of smoking (34% vs. 62%, p<0.01). The common causes with CE were atrial fibrillation (47%), and malignant tumor (9%), and cardiomyopathy (5%), and patent foramen ovale (4%). Only 20% of patients with CE were treated with anti-coagulant therapy. The rate of distal infarction site (defined as #4, #8, #14–15) was significantly higher in CE group than non-CE group (54.0% vs. 4.9%, p<0.01). During median follow-up of 53.6 [32.6–77.3] months, CE and thromboembolism recurred in 5 patients (CE: 1 patient, stroke 4 patients). The 4-year incidence of all-cause death was significantly higher in the CE group, but cardiac death was not significantly different between the groups (28.8% vs. 14.8%, p=0.03; 12.8% vs. 5.1%, p=0.11). Conclusion Compared with non-CE group, the prevalence of distal infarction site was significantly higher in the CE group, and the incidence of cardiac death is not significantly different. Funding Acknowledgement Type of funding source: None
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Hata et al. (2020) conducted a cohort in Acute myocardial infarction (n=2,695). Coronary artery embolism vs. Non-coronary artery embolism was evaluated on 4-year incidence of all-cause death (p=0.03). Coronary artery embolism in patients with acute myocardial infarction was associated with a significantly higher 4-year incidence of all-cause death compared to non-CE patients (28.8% vs. 14.8%, p=0.03).
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