Incidence of Coronary Embolism in Group of Patients with Atrial Fibrillation and Myocardial Infarction

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 = 6.765.2). 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.