Coronary Embolism in Atrial Fibrillation: A Distinct High‐Risk Phenotype With Residual Thromboembolic Risk Despite Anticoagulation

Journal of the American Heart Association, Volume 15, Issue 9 , May 5, 2026. BackgroundCoronary 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.MethodsThis 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.ResultsCE 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.