Observational studyClinical research in cardiology : official journal of the German Cardiac Society2026
Type 1 and type 2 NSTEMI in atrial fibrillation: insights from the HERA-FIB registry.
Observational study in Clinical research in cardiology : official journal of the German Cardiac Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT05995561 (Heidelberg Registry of Atrial Fibrillation), which is not on this map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Heidelberg Registry of Atrial Fibrillation
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
- Erratum issued
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDifferentiating type 1 from type 2 non-ST-elevation myocardial infarction (NSTEMI) is clinically challenging, particularly in patients with atrial fibrillation (AF), where the 4th Universal Definition of Myocardial Infarction (UDMI) allows classification based on presumed mechanisms without mandatory coronary angiography. Real-world data from AF cohorts undergoing systematic invasive evaluation remain limited.
methodsBetween 2009 and 2020, we analyzed consecutive AF patients admitted with NSTEMI to a tertiary care center. Patients undergoing early coronary angiography were included. Infarct subtypes were adjudicated according to the 4th UDMI incorporating angiographic findings. The primary objective was to determine the prevalence of type 1 and type 2 NSTEMI. The secondary endpoint was a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding.
resultsAmong 536 eligible patients, 438 (81.7%) underwent coronary angiography. Of these, 312 (71.2%) were classified as type 1 NSTEMI, 100 (22.8%) as type 2 NSTEMI, and 26 (5.9%) as acute myocardial injury. Type 2 NSTEMI was associated with preserved left ventricular function and less extensive coronary artery disease. Over a median follow-up of 2.21 years, composite event rates were 40.1% in type 1 and 36.0% in type 2 NSTEMI. Acute myocardial injury was associated with the highest composite event rate (65.4%) and all-cause mortality (57.7%).
conclusionsIn symptomatic AF patients, type 1 NSTEMI predominates and may be underdiagnosed without angiography, which enables accurate classification and timely revascularization. Type 1 and type 2 NSTEMI confer similarly high long-term risk, while acute myocardial injury identifies a particularly high-risk subgroup requiring systematic evaluation and targeted management.
trial registrationHeidelberg Registry of Atrial Fibrillation [HERA‑FIB]; NCT05995561.
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