Embolic versus non- embolic acute coronary syndrome. Prognosis differences

Type of funding sources: None.

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.

In this analysis we compare severity characteristics, management and in-hospital prognosis between an embolic cohort versus a non-embolic one among patients with left anterior descending artery as culprit vessel.

Observational, retrospective descriptive study of patients admitted in our unit from July 2011 to march 2021 for ACS. The diagnosis of CE was established according to the National Cerebral Cardiovascular Center Criteria. Data were obtained from the ARIAM Andalucia Registry.

646 Patients were analysed (19 embolic vs 627 non-embolic). There were no differences in ejection fraction (EF) (43±9% vs 44±10%, p>0.05) or Killip-Kimbal (KK) stage at admission moment (stage I more frequent in both groups) or use of inotropes or vasoactive drugs. Embolic cohort had more in-hospital complications: worse KK stage (p=0.001; KKII 23.5% vs 15.3%; KKIII 23.5% vs 5.9%), more thrombocytopenia (5.3% vs 0.8%, p=0.046) and higher hsTnT levels (p=0.000). There was more use of non-invasive mechanical ventilation in embolic group (21.1% vs 4.9%, p=0.002). Without differences in incidence of cardiac arrest, mechanical complications, bradycardia, hemorrhage or in-hospital dead.

Conservative management was more frequent in the embolic group. Percutaneous coronary intervention was the most frequent strategy in both cohorts (14.3% vs 3%; 85.6% vs 92.3%; p<0.05). At discharge, there were not significant differences in antithrombotic or anticoagulant therapy.

In our series the embolic group had worse KK stage and more need of non-invasive mechanical ventilation. They had no significant differences in EF, other mayor complications nor in-hospital mortality.