{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:03:04Z","timestamp":1785250984827,"version":"3.55.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,5,5]]},"abstract":"\n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective cohort study leveraged routinely collected electronic health records and regional death registry data from a tertiary hospital in China (2014\u20132023). Among 4777 patients with AMI, CE was diagnosed using a 3\u2010stage 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\u2010CE AMI with AF (n=205), and non\u2010CE 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\u2010risk analysis were applied for comparative outcome analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n CE accounted for 1.6% (95% CI, 1.3%\u20132.0%) of all AMI cases and was present in 14.7% to 27.6% of AF\u2010related AMI. Compared with non\u2010CE AMI patients without AF, those with CE and AF had significantly higher risks of all\u2010cause mortality (overlap\u2010weighted hazard ratio [HR], 1.77 [95% CI, 1.15\u20132.71]) and ischemic stroke (overlap\u2010weighted HR, 4.45 [95% CI, 2.34\u20138.45]), despite 79.2% receiving therapeutic anticoagulation.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n CE complicating AF represents a high\u2010risk phenotype characterized by high residual thromboembolic risk despite anticoagulation. An integrated management strategy is proposed for future investigation, incorporating multimodal imaging, embolism\u2010targeted reperfusion, and optimization of antithrombotic therapy, including standard\u2010dose direct oral anticoagulants.<\/jats:p>\n <\/jats:sec>\n \n Registration<\/jats:title>\n \n URL:\n https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n ; Unique identifier: NCT06845956.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.125.045749","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:21:11Z","timestamp":1777458071000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Coronary Embolism in Atrial Fibrillation: A Distinct High\u2010Risk Phenotype With Residual Thromboembolic Risk Despite Anticoagulation"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3602-4035","authenticated-orcid":false,"given":"Jinsong","family":"Cheng","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]},{"name":"Ningbo Clinical Guidance Center for Cardiovascular Disease Prevention and Treatment","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0013-667X","authenticated-orcid":false,"suffix":"MCM","given":"Hengyi","family":"Mao","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3397-9259","authenticated-orcid":false,"given":"Minfang","family":"Guan","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0835-1134","authenticated-orcid":false,"given":"Hanbin","family":"Cui","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]},{"name":"Zhejiang Provincial Key Laboratory of Precision Medicine for Atherosclerotic Diseases","place":["Ningbo, China"]},{"name":"Ningbo Clinical Research Center for Cardiovascular Diseases","place":["Ningbo, 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