Clinical predictors and angiographic features of acute myocardial infarction due to systemic embolism

ABSTRACT Introduction and objectives: Systemic coronary artery embolism is one of the mechanisms of acute myocardial infarction of nonatherosclerotic origin. However, the epidemiological, clinical, and angiographic profile of this entity has not been properly established yet. Our objective was to describe the clinical characteristics, angiographic features, and prognosis of acute coronary syndromes (ACS) due to systemic embolism (ACS-E), compare them to those due to coronary atherosclerosis (ACS-A), and identify predictive clinical factors of ACS-E. Methods: All consecutive patients with ACS—admitted to a tertiary hospital from 2003 through 2018—were classified as ACS-E (n = 40) or ACS-A (n = 4989), and prospectively recruited on a multipurpose database. Results: Patients with ACS-E were younger (27.5% vs 9.6% were < 45 years old, P < .001), more often women (42.5% vs 22.5%, P = .003), and had higher rates of atrial fibrillation (AF) (40.0% vs 5.3%, P < .001), previous stroke (15.0% vs 3.6%, P < .001), active neoplasms (17.5% vs 6.9%, P =.009), and previous valvular surgery (12.5% vs 0.5%, P < .001). Also, a higher proportion of them were on warfarin (27.5% vs 2.9%, P < .001). The most frequent culprit vessel was the left anterior descending coronary artery in both groups. A percutaneous coronary intervention was attempted in all patients with ACS-A, and in 75.0% of those with ACS-E (P < .001) being successful in 99.1% and 80.0%, respectively. The in-hospital all-cause mortality rate was 15.0% regarding ACS-E, and 4.0% in the control group (P < .001). A multivariate analysis was performed to study the independent predictors of ACS-E, identify AF, previous valvular surgery, and active neoplasms, younger age, and female sex. Conclusions: ACS-E and ACS-A have different clinical and angiographic characteristics. Atrial fibrillation, previous valvular surgery, active neoplasms, younger age, and female sex were all independent predictors of ACS-E.