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Shibata T, Kawakami S, Noguchi T, Tanaka T, Asaumi Y, Kanaya T, Nagai T, Nakao K, Fujino M, Nagatsuka K, Ishibashi-Ueda H, Nishimura K, Miyamoto Y, Kusano K, Anzai T, Goto Y, Ogawa H, Yasuda S. Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Attributable to Coronary Artery Embolism. Circulation 2015. [PMID: 26216084 DOI: 10.1161/circulationaha.114.015134] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Coronary artery embolism (CE) is recognized as an important nonatherosclerotic cause of acute myocardial infarction. Its prevalence, clinical features, and prognosis remain insufficiently characterized. METHODS AND RESULTS We screened 1776 consecutive patients who presented with de novo acute myocardial infarction between 2001 and 2013. CE was diagnosed based on criteria encompassing histological, angiographic, and other diagnostic imaging findings. The prevalence, clinical characteristics, treatment strategies, in-hospital outcomes, and long-term risk of CE recurrence or major adverse cardiac and cerebrovascular events (cardiac death, fatal arrhythmia, or recurrent thromboembolism) were evaluated. The prevalence of CE was 2.9% (n=52), including 8 (15%) patients with multivessel CE. Atrial fibrillation was the most common cause (n=38, 73%). Only 39% of patients with CE were treated with vitamin K antagonists, and the median international normalized ratio was 1.42 (range, 0.95-1.80). Eighteen of the 30 CE patients with nonvalvular atrial fibrillation had a CHADS2 score of 0 or 1. When those patients were reevaluated using CHA2DS2-VASc, 61% were reassigned to a higher risk category. During a median follow-up of 49 months, CE and thromboembolism recurred in 5 atrial fibrillation patients. The 5-year rate of major adverse cardiac and cerebrovascular events was 27.1%. In the propensity score-matched cohorts (n=45 each), Kaplan-Meier analysis showed a significantly higher incidence of cardiac death in the CE group than in the non-CE group (hazard ratio, 9.29; 95% confidence interval, 1.13-76.5; P<0.001). CONCLUSIONS Atrial fibrillation is the most frequent cause of CE. Patients with CE represent a high-risk subgroup of patients with acute myocardial infarction and require close follow-up.
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Affiliation(s)
- Tatsuhiro Shibata
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shoji Kawakami
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Tomotaka Tanaka
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasuhide Asaumi
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoaki Kanaya
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toshiyuki Nagai
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuhiro Nakao
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masashi Fujino
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuyuki Nagatsuka
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hatsue Ishibashi-Ueda
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kunihiro Nishimura
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Miyamoto
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo Kusano
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toshihisa Anzai
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoichi Goto
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hisao Ogawa
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- From Departments of Cardiovascular Medicine (T.S., S.K., T. Noguchi, Y.A., T.K., T. Nagai, K. Nakao, M.F., K.K., T.A., Y.G., H.O., S.Y.), Stroke and Cerebrovascular Disease (T.T., K. Nagatsuka), Pathology (H.I.-U.), and Preventive Medicine and Epidemiologic Informatics, Center for Cerebral and Cardiovascular Disease Information (K. Nishimura, Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
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