Incidence of Coronary Embolism in Group of Patients with Atrial Fibrillation and Myocardial Infarction
- Authors: Soloveva M.V.1, Boldueva S.A.1
-
Affiliations:
- North-Western State Medical University named after I.I. Mechnikov
- Issue: Vol 2, No 3 (2022)
- Pages: 31-38
- Section: Original Research
- URL: https://journal-vniispk.ru/cardar/article/view/120364
- DOI: https://doi.org/10.17816/cardar111979
- ID: 120364
Cite item
Abstract
Embolic myocardial infarction (EMI) is more common than gets to be diagnosed. EMI is often associated with atrial fibrillation (AF). The incidence of this pathology, prognosis and treatment tactics remain unclear.
AIM: To assess the incidence of EMI among patients with myocardial infarction (MI), genesis of coronary embolism (CE), initial characteristics, treatment and prognosis in group of patients with EMI.
MATERIALS AND METHODS: The group of patients with EMI was selected among 1989 patients with MI admitted to the cardiology department of the North-Western State Medical University named after I.I. Mechnikov between 2013 to December 2019. The CE verification criteria were the SUITA criteria. Statistical data processing was carried out using the SAS program.
RESULTS: 16 cases of EMI were registered (0.8% of all MI and 4.3% of patients with MI and AF). 68.7% (95% CI = 41.5%–88.9%) of patients with EMI had AF. All patients with EMI and AF did not have adequate anticoagulant therapy before admission. Among patients with EMI, men predominated, they were younger, had fewer comorbidities than patients with MI and without AF. 13 of 16 patients with EMI were prescribed anticoagulants. During hospitalization, the composite endpoint (pulmonary embolism + stroke + cardiovascular death) was recorded in 25% (95% CI = 7.3%–52.2%), in the long-term period — in 30% of cases (95 % CI = 6.7–65.2). All these patients had AF. EMI in patients with AF was associated with the development of severe chronic heart failure (CHF) by the time of discharge and with decompensation of CHF in the long-term period.
CONCLUSIONS: EMI often occur in group of patients with AF, always in the absence of adequate anticoagulant therapy. Patients with EMI and AF have a worse prognosis due to recurrent thromboembolic events.
Keywords: anticoagulants; atrial fibrillation; coronary embolism; embolic myocardial infarction; prognosis; thrombaspiration.
Full Text
##article.viewOnOriginalSite##About the authors
Mariia V. Soloveva
North-Western State Medical University named after I.I. Mechnikov
Author for correspondence.
Email: morethantea@rambler.ru
ORCID iD: 0000-0002-3335-4986
SPIN-code: 7355-6689
cardiologist, assistant of the department of faculty therapy
Russian Federation, Saint-PetersburgSvetlana A. Boldueva
North-Western State Medical University named after I.I. Mechnikov
Email: svetlanaboldueva@mail.ru
ORCID iD: 0000-0002-1898-084X
SPIN-code: 3716-3375
д-р мед. наук, профессор, заведующий кафедры факультетской терапии
Russian Federation, Saint-PetersburgReferences
- Frolov AA, Sharabrin EG, Savenkov AG, Botova SN. Embologenic myocardial infarction: the view of endovascular surgeon. Cardiology. News, Opinions, Training. 2016;(2):54–58. (In Russ.).
- Popovic B, Agrinier N, Bouchahda N, et al. Coronary embolism among ST-segment–elevation myocardial infarction patients. Mechanisms and management. Circulation. Cardiovascular interventions. 2018;11(1):e005587. doi: 10.1161/CIRCINTERVENTIONS.117.005587
- Shibata T, Kawakami S, Noguchi T, et al. Prevalence, clinical features, and prognosis of acute myocardial infarction attributable to coronary artery embolism. Circulation. 2015;132(4):241–250. doi: 10.1161/CIRCULATIONAHA.114.015134
- Prizel KR, Hutchins GM, Bulkley BH. Coronary artery embolism and myocardial infarction. A clinicopathologic study of 55 patients. Ann Intern Med. 1978;88(2):155–161. doi: 10.7326/0003-4819-88-2-155
- Boldueva SA, Soloveva MV, Oblavatckii DV, Feoktistova VS. Myocardial Infarction in the Group of Patients With Atrial Fibrillation. Kardiologiia. 2020;60(1):53–61. (In Russ.). doi: 10.18087/cardio.2020.1.n620
- Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction 2018. Eur Heart J. 2018;40(3):237–269. doi: 10.1093/eurheartj/ehy462
- Manchurov VN, Anisimov KV, Oskanov MB, et al. Myocardial infarction due to coronary artery embolism. Kardiologiia. 2018;58(2):83–90. (In Russ.). doi: 10.18087/cardio.2018.2.10090
- Huang AL, Murphy JC, Shaw E, et al. Routine aspiration thrombectomy improves the diagnosis and management of embolic myocardial infarction. Catheter Cardiovasc Interv. 2016;87(4): 642–647. doi: 10.1002/ccd.26047
- Solov’eva MV. Osobennosti techeniya i prognoz infarkta miokarda u bol’nykh s fibrillyatsiei predserdii [dissertation abstract]. Saint Petersburg, 2022. 24 p. (In Russ.).
- Ruda MYa, Averkov OV, Golitsyn SP, et al. Diagnosis and management of ST-segment elevation myocardial infarction. Russian cardiology bulletin. 2014;9(4):3–60. (In Russ.).
- Ruda MY, Averkov OV, Panchenko EP, Yavelov IS. Recommendations of the Society of Specialists in Urgent Cardiology. Diagnosis and Treatment of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. Part 1. Kardiologiia. 2017;57(8):80–100. (In Russ.). DOI: 10087/cardio.2017.8.10023
- Ruda MY, Averkov OV, Panchenko EP, Yavelov IS. Recommendations of the Society of Specialists in Urgent Cardiology Diagnosis and Treatment of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. Part 2. Kardiologiia. 2017;57(9):83–96. (In Russ.). DOI: 10087/cardio.2017.9.10026
- Rao AK, Pratt C, Berke A, et al. Thrombolysys in Myocardial Infarction (TIMI) Trial-phase I: hemorragic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J Am Coll Cardiol. 1988;11(1):1–11. doi: 10.1016/0735-1097(88)90158-1
- Jiao Z-Y, Zhang D-P, Xia K, et al. Clinical analysis of acute myocardial infarction caused by coronary embolism. J Thorac Dis. 2017;9(9):2898–2903. doi: 10.21037/jtd.2017.07.92
- Kolodgie FD, Virmani R, Finn AV, Romero ME. Embolic myocardial infarction as a consequence of atrial fibrillation a prevailing disease of the future. Circulation. 2015;132(4):223–226. doi: 10.1161/CIRCULATIONAHA.115.017534
- Roffi M, Patrono C, Collet J-P, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2016;37(3):267–315. doi: 10.1093/eurheartj/ehv320
- Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893–2962. doi: 10.1093/eurheartj/ehw210
- Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39(2):119–177. doi: 10.1093/eurheartj/ehx393
Supplementary files
