BackgroundCoronary embolism (CE) is an uncommon cause of non‐atherosclerotic acute myocardial infarction (AMI). Although atrial fibrillation (AF) is the main cause of CE, evidence of clinical, biochemical, echocardiographic, angiographic findings and outcomes of AF CE is lacking.MethodsWe retrospectively analyzed 85 consecutive patients with CE that was diagnosed based on criteria encompassing clinical, angiographic and diagnostic imaging findings. We classified patients according to AF CE or non‐AF CE.ResultsForty‐five patients presented with AF CE (53%). Patients with AF CE were older (76 ± 12 vs. 63 ± 14 years; p < 0.001) and had more often chronic kidney disease (24% vs. 5%; p = 0.01). AF CE had lower estimated glomerular filtration rate at admission (59 ± 18 vs. 77 ± 16 ml/min/1.73 m2; p < 0.001) and higher brain natriuretic peptide levels (512 ± 417 vs. 210 ± 479 pg/ml; p = 0.02). Coronary arteriography revealed a higher incidence of coronary artery obstruction in the AF CE group (73% vs. 38%; p = 0.001) without differences in interventional management. The AF CE group showed higher left atrial volume index (LAVI) (42 ± 15 vs. 25 ± 12 ml/m2; p < 0.001) and showed lower left atrium ejection fraction (LAEF) (32 ± 17 vs. 49 ± 17%; p = 0.001). In the multivariable analysis AF CE (OR 10 [95% CI 1.04–95; p = 0.046]) and LAEF (OR 0.94 [95% CI 0.88–0.99; p = 0.02]) were associated with worse in‐hospital outcomes. Moreover, in the multivariable analysis, prior stroke (OR 12.5 [95% CI 1.1–137; p = 0.04]) and LAVI (OR 1.1 [95% CI 1.03–1.14; p = 0.003]) were independently associated with worse long‐term outcomes.ConclusionAF CE has specific characteristics compared to non‐AF‐CE and it is associated with more in‐hospital events. Furthermore, atrial cardiopathy is associated with worse in‐hospital and long‐term outcomes in this setting.

中文翻译：

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房颤与非房颤冠状动脉栓塞


背景冠状动脉栓塞（CE）是非动脉粥样硬化性急性心肌梗死（AMI）的罕见原因。虽然心房颤动 (AF) 是 CE 的主要原因，但缺乏 AF CE 的临床、生化、超声心动图、血管造影结果和结果的证据。方法我们回顾性分析了 85 例连续的 CE 患者，这些患者是根据临床、血管造影和超声检查标准诊断的。诊断影像学结果。我们根据 AF CE 或非 AF CE 对患者进行分类。结果 45 名患者出现 AF CE (53%)。 AF CE 患者年龄较大（76 ± 12 岁 vs. 63 ± 14 岁；p < 0.001），并且更常患有慢性肾病（24% vs. 5%；p = 0.01）。 AF CE 入院时估计肾小球滤过率较低（59 ± 18 vs. 77 ± 16 ml/min/1.73 m2；p < 0.001），脑钠尿肽水平较高（512 ± 417 vs. 210 ± 479 pg/ml；p < 0.001）。 p = 0.02）。冠状动脉造影显示 AF CE 组冠状动脉阻塞的发生率较高（73% vs. 38%；p = 0.001），介入治疗没有差异。 AF CE 组显示出较高的左心房容积指数 (LAVI)（42 ± 15 vs. 25 ± 12 ml/m2；p < 0.001），并显示出较低的左心房射血分数 (LAEF)（32 ± 17 vs. 49 ± 17） %；p = 0.001)。在多变量分析中，AF CE（OR 10 [95% CI 1.04–95；p = 0.046]）和 LAEF（OR 0.94 [95% CI 0.88–0.99；p = 0.02]）与较差的院内结局相关。此外，在多变量分析中，既往卒中（OR 12.5 [95% CI 1.1-137；p = 0.04]）和LAVI（OR 1.1 [95% CI 1.03-1.14；p = 0.003]）与较差的长期预后独立相关。结论 AF CE 与非 AF-CE 相比具有特定的特征，并且与更多的院内事件相关。 此外，在这种情况下，心房性心脏病与较差的院内和长期结局相关。