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Real-world data from AF cohorts undergoing systematic invasive evaluation remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between 2009 and 2020, we analyzed consecutive AF patients admitted with NSTEMI to a tertiary care center. Patients undergoing early coronary angiography were included. Infarct subtypes were adjudicated according to the 4th UDMI incorporating angiographic findings. The primary objective was to determine the prevalence of type 1 and type 2 NSTEMI. The secondary endpoint was a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 536 eligible patients, 438 (81.7%) underwent coronary angiography. Of these, 312 (71.2%) were classified as type 1 NSTEMI, 100 (22.8%) as type 2 NSTEMI, and 26 (5.9%) as acute myocardial injury. Type 2 NSTEMI was associated with preserved left ventricular function and less extensive coronary artery disease. Over a median follow-up of 2.21\u00a0years, composite event rates were 40.1% in type 1 and 36.0% in type 2 NSTEMI. Acute myocardial injury was associated with the highest composite event rate (65.4%) and all-cause mortality (57.7%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In symptomatic AF patients, type 1 NSTEMI predominates and may be underdiagnosed without angiography, which enables accurate classification and timely revascularization. Type 1 and type 2 NSTEMI confer similarly high long-term risk, while acute myocardial injury identifies a particularly high-risk subgroup requiring systematic evaluation and targeted management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Heidelberg Registry of Atrial Fibrillation [HERA\u2011FIB]; NCT05995561.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-026-02912-8","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T07:29:29Z","timestamp":1776238169000},"page":"1856-1869","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Type 1 and type 2 NSTEMI in atrial fibrillation: insights from the HERA-FIB registry"],"prefix":"10.1007","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6783-143X","authenticated-orcid":false,"given":"Mustafa","family":"Yildirim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1799-545X","authenticated-orcid":false,"given":"Christian","family":"Salbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"D\u00fcrr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1711-1423","authenticated-orcid":false,"given":"Matthias","family":"Mueller-Hennessen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2293-2314","authenticated-orcid":false,"given":"Hugo A.","family":"Katus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7611-378X","authenticated-orcid":false,"given":"Norbert","family":"Frey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1025-2872","authenticated-orcid":false,"given":"Evangelos","family":"Giannitsis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"2912_CR1","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1093\/eurheartj\/ehy462","volume":"40","author":"K Thygesen","year":"2019","unstructured":"Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Group ESCSD (2019) Fourth universal definition of myocardial infarction (2018). 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Approval was granted by the Ethics Committee of the University of Heidelberg. For this retrospective study using data from clinical routine care, informed consent was waived by the local ethical committee.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"M.M-H. received research funding from BRAHMS, Thermo Fisher Scientific and Roche Diagnostics. E.G. received honoraria for lectures from Roche Diagnostics, AstraZeneca, Bayer, Daiichi-Sankyo, Lilly Eli Deutschland. He serves as a consultant for Roche Diagnostics, BRAHMS Thermo Fisher Scientific, Boehringer Ingelheim and has received research funding from BRAHMS Thermo Fisher Scientific, Roche Diagnostics, Bayer Vital and Daiichi Sankyo. N.F. has received speaker honoraria from Daiichi Sankyo, Astra Zeneca, Boehringer Ingelheim and Bayer Vital. He serves as a consultant for CMS. There are no disclosures for J.D., H.K., C.S. and M.Y.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}