What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation with Non-ST-elevation myocardial infarction (NSTEMI) (n=438). Intervention: Type 1 NSTEMI vs. Type 2 NSTEMI. Primary outcome: Prevalence of type 1 and type 2 NSTEMI.

What question did this study set out to answer?

This research aims to differentiate between type 1 and type 2 NSTEMI occurrences in patients with atrial fibrillation.

April 17, 2026Clinical Research in Cardiology0 citationsOpen Access

Type 1 and type 2 NSTEMI in atrial fibrillation: insights from the HERA-FIB registry

MYMustafa Yildirim CSChristian Salbach JDJ. Dürr

Key Result

Type 1 NSTEMI was the predominant mechanism in symptomatic atrial fibrillation patients presenting with NSTEMI, occurring in 71.2% of cases compared to 22.8% for Type 2 NSTEMI.

Key Points

This research aims to differentiate between type 1 and type 2 NSTEMI occurrences in patients with atrial fibrillation.
Analysis of data from the HERA-FIB registry
Focus on patients diagnosed with atrial fibrillation
Comparison of clinical characteristics and outcomes for type 1 and type 2 NSTEMI
Identification of distinct clinical features associated with type 1 NSTEMI
Type 2 NSTEMI showed different hemodynamic responses compared to type 1
Findings suggest the need for tailored management strategies for NSTEMI types in atrial fibrillation

Study Design

Type

Cohort (n=438)

Multicenter

Structured PICO

What is the prevalence and prognostic impact of type 1 versus type 2 NSTEMI in patients presenting with symptomatic atrial fibrillation undergoing coronary angiography?

Population

438 adults (≥18 years) presenting with symptomatic atrial fibrillation (AF) and suspected acute coronary syndrome (ACS) who fulfilled NSTEMI criteria based on hs-cTnT dynamics and clinical symptoms, and underwent coronary angiography during index hospitalization. Mean age 77, 65.2% male, single-center (Germany).

Intervention

Type 1 NSTEMI (adjudicated based on angiographic findings and 4th UDMI criteria)

Comparator

Type 2 NSTEMI (adjudicated based on absence of type 1 criteria and presence of oxygen demand/supply mismatch triggers) and acute myocardial injury

Outcome

Angiographic prevalence of type 1 and type 2 NSTEMIcomposite

In symptomatic atrial fibrillation patients presenting with NSTEMI, type 1 MI is highly prevalent (71.2%) and carries a similar long-term risk to type 2 MI, highlighting the importance of systematic invasive evaluation for accurate classification and management.

Main Result

Absolute Event Rate: 71.2% vs 22.8%

Limitations

Retrospective, observational design limits causal inference and is vulnerable to residual confounding.
Misclassification between type 1 and type 2 MI cannot be fully ruled out due to the lack of intravascular imaging (OCT or IVUS).
Potential selection bias, although the coronary angiography rate was exceptionally high (81.7%).
Lack of data on the exact time of symptom onset.
Coronary anatomy was described only semi-quantitatively without functional significance of the culprit lesion.

Abstract

Heidelberg Registry of Atrial Fibrillation HERA‑FIB; NCT05995561.

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