{"id":"bec0da3faee0","type":"article","url":"https://hartvaat.nl/2026/05/05/coronaire-embolie-bij-atriumfibrilleren-hoog-rest-trombo-embolisch-risico-ondank/","title":"Coronaire embolie bij atriumfibrilleren: hoog rest-trombo-embolisch risico ondanks antistolling","title_en":"","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["aperitif-trial","slaapapneu"],"journal":"Journal of the American Heart Association","doi":"10.1161/JAHA.125.045749","source_url":"https://doi.org/10.1161/JAHA.125.045749","authors":["Jinsong Cheng","Hengyi Mao","Minfang Guan","Hanbin Cui"],"significance":7,"published":"2026-06-29","source_date":"2026-05-05","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/atriumfibrilleren/linkerhartoorkluiting/"],"congress":"","summary_en":"Retrospective cohort study (China, 2014-2023, n=4,777 with acute myocardial infarction) in which coronary embolism (CE) was diagnosed via a 3-step validation process (Shibata criteria, angiographic core lab, final adjudication). Patients were grouped: CE with AF (n=78), non-CE AMI with AF (n=205), and non-CE AMI without AF (n=3,937), with propensity-score overlap weighting. CE accounted for 1.6% of all AMIs and 14.7-27.6% of AF-related AMIs. Compared with non-CE AMI without AF, CE+AF patients had significantly higher all-cause mortality (aHR 1.77; 95% CI 1.15-2.71) and ischaemic stroke (aHR 4.45; 95% CI 2.34-8.45), despite 79.2% receiving therapeutic anticoagulation. CE in AF is therefore an underrecognised high-risk phenotype with residual thromboembolic risk. The authors advocate multimodal imaging, embolism-targeted reperfusion, and optimisation of antithrombotic therapy including standard-dose DOACs.","created":"2026-07-03T10:33:08Z","updated":"2026-07-03T18:39:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Retrospectieve cohortstudie (China, 2014-2023, n=4.777 met acuut myocardinfarct) waarin coronaire embolie (CE) werd gediagnosticeerd via een 3-staps validatieproces (Shibata-criteria, angiografisch corelab, eindadjudicatie). Patiënten werden gegroepeerd: CE met AF (n=78), niet-CE AMI met AF (n=205) en niet-CE AMI zonder AF (n=3.937), met overlap-weging via propensity-scores. CE besloeg 1,6% van alle AMI's en 14,7-27,6% van AF-gerelateerde AMI's. Vergeleken met niet-CE AMI zonder AF hadden CE+AF-patiënten significant hogere totale sterfte (aHR 1,77; 95%-BI 1,15-2,71) en ischemisch CVA (aHR 4,45; 95%-BI 2,34-8,45), ondanks therapeutische antistolling bij 79,2%. CE bij AF is dus een onderbelichte hoogrisico-fenotype met residueel trombo-embolisch risico. De auteurs pleiten voor multimodale beeldvorming, embolie-gerichte reperfusie en optimalisatie van antitrombotische therapie inclusief standaarddoses DOAC.","abstract_original":"BACKGROUND: Coronary embolism (CE) is an underrecognized cause of acute myocardial infarction (AMI) in patients with atrial fibrillation (AF). Dedicated management guidelines are lacking because of limited evidence. METHODS: This retrospective cohort study leveraged routinely collected electronic health records and regional death registry data from a tertiary hospital in China (2014-2023). Among 4777 patients with AMI, CE was diagnosed using a 3-stage validation process: modified Shibata criteria, blinded angiographic core laboratory assessment, and final adjudication. Patients were categorized into 3 groups: CE with AF (n=78), non-CE AMI with AF (n=205), and non-CE AMI without AF (n=3937). Overlap weighting based on propensity scores was used to balance baseline covariates, and weighted Cox proportional hazards models with competing-risk analysis were applied for comparative outcome analyses. RESULTS: CE accounted for 1.6% (95% CI, 1.3%-2.0%) of all AMI cases and was present in 14.7% to 27.6% of AF-related AMI. Compared with non-CE AMI patients without AF, those with CE and AF had significantly higher risks of all-cause mortality (overlap-weighted hazard ratio [HR], 1.77 [95% CI, 1.15-2.71]) and ischemic stroke (overlap-weighted HR, 4.45 [95% CI, 2.34-8.45]), despite 79.2% receiving therapeutic anticoagulation. CONCLUSIONS: CE complicating AF represents a high-risk phenotype characterized by high residual thromboembolic risk despite anticoagulation. An integrated management strategy is proposed for future investigation, incorporating multimodal imaging, embolism-targeted reperfusion, and optimization of antithrombotic therapy, including standard-dose direct oral anticoagulants. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06845956."}