Observational studyJournal of the American Heart Association2026
Coronary Embolism in Atrial Fibrillation: A Distinct High-Risk Phenotype With Residual Thromboembolic Risk Despite Anticoagulation.
Observational study in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06845956 (Prevalence, Clinical Features, and Prognosis of Coronary Artery Embolism With Concomitant Atrial Fibrillation), which is not on this map. Not yet cited in PubMed.
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Prevalence, Clinical Features, and Prognosis of Coronary Artery Embolism With Concomitant Atrial Fibrillation
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4 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundCoronary embolism (CE) is an underrecognized cause of acute myocardial infarction (AMI) in patients with atrial fibrillation (AF). Dedicated management guidelines are lacking because of limited evidence.
methodsThis retrospective cohort study leveraged routinely collected electronic health records and regional death registry data from a tertiary hospital in China (2014-2023). Among 4777 patients with AMI, CE was diagnosed using a 3-stage validation process: modified Shibata criteria, blinded angiographic core laboratory assessment, and final adjudication. Patients were categorized into 3 groups: CE with AF (n=78), non-CE AMI with AF (n=205), and non-CE AMI without AF (n=3937). Overlap weighting based on propensity scores was used to balance baseline covariates, and weighted Cox proportional hazards models with competing-risk analysis were applied for comparative outcome analyses.
resultsCE accounted for 1.6% (95% CI, 1.3%-2.0%) of all AMI cases and was present in 14.7% to 27.6% of AF-related AMI. Compared with non-CE AMI patients without AF, those with CE and AF had significantly higher risks of all-cause mortality (overlap-weighted hazard ratio [HR], 1.77 [95% CI, 1.15-2.71]) and ischemic stroke (overlap-weighted HR, 4.45 [95% CI, 2.34-8.45]), despite 79.2% receiving therapeutic anticoagulation.
conclusionsCE complicating AF represents a high-risk phenotype characterized by high residual thromboembolic risk despite anticoagulation. An integrated management strategy is proposed for future investigation, incorporating multimodal imaging, embolism-targeted reperfusion, and optimization of antithrombotic therapy, including standard-dose direct oral anticoagulants. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06845956.
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