Clinical predictors and angiographic features of acute coronary syndromes caused by systemic embolism

Clinical predictors and angiographic features of acute coronary syndromes caused by systemic embolism

Abstract Introduction Systemic embolism to coronary arteries is one of the mechanisms of acute myocardial infarction (AMI) of non-atherosclerotic cause. However, its clinical profile has not been properly established yet. Purpose To identify clinical predictors and angiographic characteristics of ac...

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Veröffentlicht in:European heart journal 2020-11, Vol.41 (Supplement_2)
Hauptverfasser: Jeronimo Baza, A, Salazar, C, Perez Vyzcaino, M.J, Nombela, L, Jimenez Quevedo, P, Nunez, I, Salinas, P, Mejia, H, Escaned, J, Fernandez Ortiz, A, Ferrandez Escarabajal, M, Martinez Gomez, E, Ramos Lopez, N, Gonzalo, N
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container_issue Supplement_2
container_start_page
container_title European heart journal
container_volume 41
creator Jeronimo Baza, A
Salazar, C
Perez Vyzcaino, M.J
Nombela, L
Jimenez Quevedo, P
Nunez, I
Salinas, P
Mejia, H
Escaned, J
Fernandez Ortiz, A
Ferrandez Escarabajal, M
Martinez Gomez, E
Ramos Lopez, N
Gonzalo, N
description Abstract Introduction Systemic embolism to coronary arteries is one of the mechanisms of acute myocardial infarction (AMI) of non-atherosclerotic cause. However, its clinical profile has not been properly established yet. Purpose To identify clinical predictors and angiographic characteristics of acute coronary syndromes caused by systemic embolism to a principal coronary artery (ACS-E), as well as to describe in-hospital mortality of these patients. Methods 40 patients with ACS-E, admitted between 2003 and 2018 in a tertiary hospital. Epidemiological, clinical and angiographic characteristics of these cases were compared with those from 4989 patients, attended for acute coronary syndrome of atherosclerotic cause (ACS-A) in the same hospital during the same period. Results Patients with ACS-E were younger (28% vs 10% were
doi_str_mv 10.1093/ehjci/ehaa946.1530
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However, its clinical profile has not been properly established yet. Purpose To identify clinical predictors and angiographic characteristics of acute coronary syndromes caused by systemic embolism to a principal coronary artery (ACS-E), as well as to describe in-hospital mortality of these patients. Methods 40 patients with ACS-E, admitted between 2003 and 2018 in a tertiary hospital. Epidemiological, clinical and angiographic characteristics of these cases were compared with those from 4989 patients, attended for acute coronary syndrome of atherosclerotic cause (ACS-A) in the same hospital during the same period. Results Patients with ACS-E were younger (28% vs 10% were <45 years old, p<0.001) and had a higher proportion of women (43% vs 22%, p 0.003), atrial fibrillation (40% vs 5%, p<0.001) and neoplasia (18% vs 7%, p 0.009). They had also undergone previous valvular surgery more frequently than patients with ACS-A (13% vs 0.5%, p<0.001) and a higher proportion of them were under treatment with warfarin (15% vs 3%, p<0.001). Variables identified as independent predictors of ACS-E in the multivariate analysis are shown in the table. Regarding clinical presentation, ST elevation AMI was more frequent in ACS-E cases (83% vs 67%, p 0.04). Patients with ACS-E did not present any significative stenosis in other vessels apart from the culprit one (number of other vessels with at least 1 severe stenosis was 0 in the ACS-E group vs 1.33 + 1 in the ACS-A arm, p<0.001). PCI was attempted in 75% of the patients with ACS-E, resulting successful in 80% of the cases. On the other hand, 100% of SCA-A underwent PCI, with a success proportion of 99% (p<0.001). In-hospital mortality in ACS-E group was 15% and 4% in the control group (p<0.001). Conclusions ACS-E and ACS-A have different clinical and angiographic features. Atrial fibrillation, chronic warfarin treatment, previous valvular surgery, presence of any neoplasia and female sex are independent predictors for ACS-E. Multivariate analysis to identify clinical predictors for ACS-E Odds Ratio p value Age 1.06 (1.03–1.08) <0.001 Female sex (%) 2.78 (1.37–5.65) 0.007 Neoplasia 3.37 (1.33–8.54) 0.02 Valvular surgery 4.28 (1.19–15.5) 0.04 Atrial fibrillation 16.1 (7.23–35.9) <0.001 Treatment with warfarin 5.78 (2.46–13.55) <0.001 Funding Acknowledgement Type of funding source: None]]></description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/ehjci/ehaa946.1530</identifier><language>eng</language><publisher>Oxford University Press</publisher><ispartof>European heart journal, 2020-11, Vol.41 (Supplement_2)</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27907,27908</link.rule.ids></links><search><creatorcontrib>Jeronimo Baza, A</creatorcontrib><creatorcontrib>Salazar, C</creatorcontrib><creatorcontrib>Perez Vyzcaino, M.J</creatorcontrib><creatorcontrib>Nombela, L</creatorcontrib><creatorcontrib>Jimenez Quevedo, P</creatorcontrib><creatorcontrib>Nunez, I</creatorcontrib><creatorcontrib>Salinas, P</creatorcontrib><creatorcontrib>Mejia, H</creatorcontrib><creatorcontrib>Escaned, J</creatorcontrib><creatorcontrib>Fernandez Ortiz, A</creatorcontrib><creatorcontrib>Ferrandez Escarabajal, M</creatorcontrib><creatorcontrib>Martinez Gomez, E</creatorcontrib><creatorcontrib>Ramos Lopez, N</creatorcontrib><creatorcontrib>Gonzalo, N</creatorcontrib><title>Clinical predictors and angiographic features of acute coronary syndromes caused by systemic embolism</title><title>European heart journal</title><description><![CDATA[Abstract Introduction Systemic embolism to coronary arteries is one of the mechanisms of acute myocardial infarction (AMI) of non-atherosclerotic cause. However, its clinical profile has not been properly established yet. Purpose To identify clinical predictors and angiographic characteristics of acute coronary syndromes caused by systemic embolism to a principal coronary artery (ACS-E), as well as to describe in-hospital mortality of these patients. Methods 40 patients with ACS-E, admitted between 2003 and 2018 in a tertiary hospital. Epidemiological, clinical and angiographic characteristics of these cases were compared with those from 4989 patients, attended for acute coronary syndrome of atherosclerotic cause (ACS-A) in the same hospital during the same period. Results Patients with ACS-E were younger (28% vs 10% were <45 years old, p<0.001) and had a higher proportion of women (43% vs 22%, p 0.003), atrial fibrillation (40% vs 5%, p<0.001) and neoplasia (18% vs 7%, p 0.009). They had also undergone previous valvular surgery more frequently than patients with ACS-A (13% vs 0.5%, p<0.001) and a higher proportion of them were under treatment with warfarin (15% vs 3%, p<0.001). Variables identified as independent predictors of ACS-E in the multivariate analysis are shown in the table. Regarding clinical presentation, ST elevation AMI was more frequent in ACS-E cases (83% vs 67%, p 0.04). Patients with ACS-E did not present any significative stenosis in other vessels apart from the culprit one (number of other vessels with at least 1 severe stenosis was 0 in the ACS-E group vs 1.33 + 1 in the ACS-A arm, p<0.001). PCI was attempted in 75% of the patients with ACS-E, resulting successful in 80% of the cases. On the other hand, 100% of SCA-A underwent PCI, with a success proportion of 99% (p<0.001). In-hospital mortality in ACS-E group was 15% and 4% in the control group (p<0.001). Conclusions ACS-E and ACS-A have different clinical and angiographic features. Atrial fibrillation, chronic warfarin treatment, previous valvular surgery, presence of any neoplasia and female sex are independent predictors for ACS-E. Multivariate analysis to identify clinical predictors for ACS-E Odds Ratio p value Age 1.06 (1.03–1.08) <0.001 Female sex (%) 2.78 (1.37–5.65) 0.007 Neoplasia 3.37 (1.33–8.54) 0.02 Valvular surgery 4.28 (1.19–15.5) 0.04 Atrial fibrillation 16.1 (7.23–35.9) <0.001 Treatment with warfarin 5.78 (2.46–13.55) <0.001 Funding Acknowledgement Type of funding source: None]]></description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqNkM1qwzAMgM3YYF23F9jJL5DOjn-aHEfZHxR26WG3oMhK65LEwU4Offulax9gB0kg6RPiY-xZipUUpXqhwxH9nAFKbVfSKHHDFtLkeVZabW7ZQsjSZNYWP_fsIaWjEKKw0i4YbVrfe4SWD5GcxzHExKF3c-x92EcYDh55QzBOkRIPDQecRuIYYughnng69S6Gbp4hTIkcr8-9NFI3c9TVofWpe2R3DbSJnq51yXbvb7vNZ7b9_vjavG4zlLkRmVuDQS2VQt1o2dhyrYtaUa7JgiuEqVVRkFDoJICQWggyzpVYE8q1rnO1ZPnlLMaQUqSmGqLv5i8rKaqzp-rPU3X1VJ09zVB2gcI0_Gf_F8O6b6Y</recordid><startdate>20201101</startdate><enddate>20201101</enddate><creator>Jeronimo Baza, A</creator><creator>Salazar, C</creator><creator>Perez Vyzcaino, M.J</creator><creator>Nombela, L</creator><creator>Jimenez Quevedo, P</creator><creator>Nunez, I</creator><creator>Salinas, P</creator><creator>Mejia, H</creator><creator>Escaned, J</creator><creator>Fernandez Ortiz, A</creator><creator>Ferrandez Escarabajal, M</creator><creator>Martinez Gomez, E</creator><creator>Ramos Lopez, N</creator><creator>Gonzalo, N</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20201101</creationdate><title>Clinical predictors and angiographic features of acute coronary syndromes caused by systemic embolism</title><author>Jeronimo Baza, A ; Salazar, C ; Perez Vyzcaino, M.J ; Nombela, L ; Jimenez Quevedo, P ; Nunez, I ; Salinas, P ; Mejia, H ; Escaned, J ; Fernandez Ortiz, A ; Ferrandez Escarabajal, M ; Martinez Gomez, E ; Ramos Lopez, N ; Gonzalo, N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1250-d7a5c4133c4f41f69748b3e24e6ad805b388e03cd1aa01400e5dd9cbec174b23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jeronimo Baza, A</creatorcontrib><creatorcontrib>Salazar, C</creatorcontrib><creatorcontrib>Perez Vyzcaino, M.J</creatorcontrib><creatorcontrib>Nombela, L</creatorcontrib><creatorcontrib>Jimenez Quevedo, P</creatorcontrib><creatorcontrib>Nunez, I</creatorcontrib><creatorcontrib>Salinas, P</creatorcontrib><creatorcontrib>Mejia, H</creatorcontrib><creatorcontrib>Escaned, J</creatorcontrib><creatorcontrib>Fernandez Ortiz, A</creatorcontrib><creatorcontrib>Ferrandez Escarabajal, M</creatorcontrib><creatorcontrib>Martinez Gomez, E</creatorcontrib><creatorcontrib>Ramos Lopez, N</creatorcontrib><creatorcontrib>Gonzalo, N</creatorcontrib><collection>CrossRef</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jeronimo Baza, A</au><au>Salazar, C</au><au>Perez Vyzcaino, M.J</au><au>Nombela, L</au><au>Jimenez Quevedo, P</au><au>Nunez, I</au><au>Salinas, P</au><au>Mejia, H</au><au>Escaned, J</au><au>Fernandez Ortiz, A</au><au>Ferrandez Escarabajal, M</au><au>Martinez Gomez, E</au><au>Ramos Lopez, N</au><au>Gonzalo, N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical predictors and angiographic features of acute coronary syndromes caused by systemic embolism</atitle><jtitle>European heart journal</jtitle><date>2020-11-01</date><risdate>2020</risdate><volume>41</volume><issue>Supplement_2</issue><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract><![CDATA[Abstract Introduction Systemic embolism to coronary arteries is one of the mechanisms of acute myocardial infarction (AMI) of non-atherosclerotic cause. However, its clinical profile has not been properly established yet. Purpose To identify clinical predictors and angiographic characteristics of acute coronary syndromes caused by systemic embolism to a principal coronary artery (ACS-E), as well as to describe in-hospital mortality of these patients. Methods 40 patients with ACS-E, admitted between 2003 and 2018 in a tertiary hospital. Epidemiological, clinical and angiographic characteristics of these cases were compared with those from 4989 patients, attended for acute coronary syndrome of atherosclerotic cause (ACS-A) in the same hospital during the same period. Results Patients with ACS-E were younger (28% vs 10% were <45 years old, p<0.001) and had a higher proportion of women (43% vs 22%, p 0.003), atrial fibrillation (40% vs 5%, p<0.001) and neoplasia (18% vs 7%, p 0.009). They had also undergone previous valvular surgery more frequently than patients with ACS-A (13% vs 0.5%, p<0.001) and a higher proportion of them were under treatment with warfarin (15% vs 3%, p<0.001). Variables identified as independent predictors of ACS-E in the multivariate analysis are shown in the table. Regarding clinical presentation, ST elevation AMI was more frequent in ACS-E cases (83% vs 67%, p 0.04). Patients with ACS-E did not present any significative stenosis in other vessels apart from the culprit one (number of other vessels with at least 1 severe stenosis was 0 in the ACS-E group vs 1.33 + 1 in the ACS-A arm, p<0.001). PCI was attempted in 75% of the patients with ACS-E, resulting successful in 80% of the cases. On the other hand, 100% of SCA-A underwent PCI, with a success proportion of 99% (p<0.001). In-hospital mortality in ACS-E group was 15% and 4% in the control group (p<0.001). Conclusions ACS-E and ACS-A have different clinical and angiographic features. Atrial fibrillation, chronic warfarin treatment, previous valvular surgery, presence of any neoplasia and female sex are independent predictors for ACS-E. Multivariate analysis to identify clinical predictors for ACS-E Odds Ratio p value Age 1.06 (1.03–1.08) <0.001 Female sex (%) 2.78 (1.37–5.65) 0.007 Neoplasia 3.37 (1.33–8.54) 0.02 Valvular surgery 4.28 (1.19–15.5) 0.04 Atrial fibrillation 16.1 (7.23–35.9) <0.001 Treatment with warfarin 5.78 (2.46–13.55) <0.001 Funding Acknowledgement Type of funding source: None]]></abstract><pub>Oxford University Press</pub><doi>10.1093/ehjci/ehaa946.1530</doi><oa>free_for_read</oa></addata></record>
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title Clinical predictors and angiographic features of acute coronary syndromes caused by systemic embolism
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