Embolic versus non- embolic acute coronary syndrome. Baseline characteristics and presentation

Abstract

Funding Acknowledgements Type of funding sources: None. Introduction Coronary embolism (CE) is a rare cause of acute coronary syndrome with current evidence from small case series. In our previous work (n=36), atrial fibrillation was the main risk factor and STEMI the most frequent presentation. Objetives In this analysis we compare baseline characteristics from an embolic versus a non-embolic cohort both with left anterior descending artery as culprit vessel. Methods Observational, retrospective descriptive study of patients admitted in our unit from July 2011 to march 2021 for acute coronary syndrome and diagnosed with CE (National Cerebral Cardiovascular Center Criteria). Comparative cohort data were analysed from ARIAM Andalucia Registry. Results 646 patients were analysed (19 embolic vs 627 non-embolic). 73.7% were women in the embolic group, 27% in the non-embolic one (p<0.05). Mean age 75±12 in the embolic cases versus 62±13 in non-embolic ones (p<0.05). 9.3% of patients had history of ischemic events and there was more previous heart failure in the embolic cohort (21.1% vs 3.0%, p<0.05%). Smoking was more frequent in the non-embolic group (43.5% vs 5.3%, p<0.05), insulin-dependent diabetes mellitus was more prevalent in the embolic cohort (21.1% vs 6.1%, p<0.05). There were no differences in other cardiovascular risk factors. AF and anticoagulation therapy were more frequent in the embolic cohort (31.6% vs 6.2%, p<0.05; 31.6% vs 5%, p<0.05). Time to first medical attention was not significantly shorter in the embolic group (95±80min vs 503±3278min, p>0.05). De novo AF was more frequent in the embolic group (31.6% vs 0.8%, p=0.02). GRACE and CRUSADE scores values were higher in embolic patients (162±31 vs 145±40, p=0.042; 45±10 vs 23±23, p=0.001). Conclusions CE is an infrequent entity. Our data suggest that in STEMI, elder women patients, with atrial fibrillation, insulin-dependent diabetes mellitus and not smoking, and with short delay to first medical attention, should rise the suspiction of this fenomenon.