Incidence and Predictors of Early Left Ventricular Thrombus After ST-Elevation Myocardial Infarction in the Contemporary Era of Primary Percutaneous Coronary Intervention

Gianstefani, Silvia; Douiri, Abdel; Delithanasis, I.; Rogers, Toby; Sen, Arup; Kalra, Sundeep; Charangwa, Langton; Reiken, Joseph; Monaghan, Mark; MacCarthy, Philip

doi:10.1016/j.amjcard.2013.12.015

Cited by 143 publications

(123 citation statements)

References 27 publications

Supporting

Mentioning

106

Contrasting

Order By: Relevance

“…Angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers could have some benefit in term of improved survival at 1 year 3. β‐Blockers showed no effect on survival and recurrence rate,3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 whereas calcium antagonists could be used if coronary vasospasm has been proven during coronary angiogram or with acetylcholine test 32…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Santoro

Stiermaier

Tarantino

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundLeft ventricular (LV) thrombi during Takotsubo syndrome represent a potential complication and can be associated with cerebrovascular embolic events. The aim of this study was to evaluate the exact incidence, predictors, and management strategies of LV thrombi in patients with Takotsubo syndrome.Methods and ResultsWe enrolled 541 consecutive patients in a multicenter international registry. Clinical features and echocardiographic data at admission, during hospitalization, and after 3 months were evaluated. Survival rates for long‐term follow‐up (mean 984±908 days) were recorded. Twelve Takotsubo syndrome patients (2.2%) developed LV thrombi (all female presenting with apical ballooning pattern). All patients with LV thrombi were treated with oral anticoagulation therapy; however, 2 (17%) had a stroke before treatment initiation. These patients were characterized by a higher prevalence of ST‐elevation (56% versus 16%; P<0.001) and higher troponin I levels (10.8±18.3 ng/mL versus 3.5±4.3 ng/mL; P=0.001) as compared with those without LV thrombi. At multivariate analysis including age, sex, LV ejection fraction, ST‐elevation at admission, and apical ballooning pattern, troponin I level >10 ng/mL was the only predictor for LV thrombosis (hazard ratio 6.6, confidence interval, 1.01–40.0; P=0.04). After 3 months all LV thrombi disappeared. Oral anticoagulation therapy was interrupted in all patients except 1. At long‐term follow‐up, the survival rate was not different between patients with and without LV thrombi (84% versus 85%; P=0.99).Conclusions LV thrombi have a relatively low incidence among patients with Takotsubo syndrome and were detected in female patients with apical ballooning pattern and increased troponin levels. Oral anticoagulation therapy for 3 months seems reasonable in these high‐risk patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Santoro

Stiermaier

Tarantino

et al. 2017

JAHA

View full text Add to dashboard Cite

show abstract

“…For instance, data from the pre-percutaneous intervention (PCI) era demonstrated a prevalence ranging from 7 to 46 % [3][4][5][6][7], while data in the PCI-era suggest a prevalence ranging from 2.5 to 15 % [8][9][10][11][12][13][14]. Anterior myocardial infarction, reduced ejection fraction (EF) and larger infarct size have previously been identified as predictors of LVT formation [9][10][11][12][13][14][15]. However, beyond these variables, few other predictors have been identified in the present era.…”

Section: Introductionmentioning

confidence: 99%

Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction

Garber

Mentz

Al‐Khalidi

et al. 2015

J Thromb Thrombolysis

View full text Add to dashboard Cite

We aimed to characterize the independent predictors of LVT following STEMI and the association with outcomes. The clinical predictors of left ventricular thrombus (LVT) formation after ST-segment elevation myocardial infarction (STEMI) are not well-defined in the contemporary era. We performed a retrospective analysis of STEMI patients at Duke from 2000 to 2011 who had a transthoracic echocardiogram within 90 days post-STEMI and compared patients with and without LVT (LVT+ vs. LVT-). Univariate Cox proportional hazards regression models of baseline characteristics were examined and significant variables were used in a multivariable model to assess adjusted relationships with LVT. A multivariable Cox PH survival model with covariate adjustments was used for assessment of LVT and long-term mortality. Of all eligible patients, 1734 patients met inclusion criteria and 4.3 % (N = 74) had a LVT. LVT+ patients tended to have a history of heart failure (HF) and higher initial troponin compared to LVT- patients. After adjustment, higher heart rate, non-white race, HF severity, and presence of left anterior descending artery (LAD) disease were independent predictors of LVT. There was a trend toward an association between LVT and increased all-cause mortality (HR 1.36; 95 % CI 0.84-2.21, P = 0.22), however this was not statistically significant. LVT was seen in over 4 % of this contemporary post-STEMI population. Several baseline characteristics were independently associated with LVT: Heart rate, HF severity, LAD disease, and non-white race. Prospective studies are warranted to determine whether anticoagulation in patients at increased risk for LVT improves outcomes.

show abstract

“…AMI, especially anterior and apical wall infarction associated with reduced left ventricular systolic function provide a substrate for the formation of left ventricular mural thrombus (11). These post AMI thrombi are particularly prone to increased risk of embolization (12,13), and may explain simultaneous CCI.…”

Section: Pathogenesis Of CCImentioning

confidence: 99%

Simultaneous acute cardio-cerebral infarction: is there a consensus for management?

et al. 2018

View full text Add to dashboard Cite

Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) are both life-threatening medical conditions with narrow therapeutic time-window that carry grave prognosis if not addressed promptly. The acute management of both condition is well documented in the literature, however the management of a simultaneous presentation of both AIS and AMI is unclear. A delayed intervention of one infarcted territory for the other may result in permanent irreversible morbidity or disability, and even death. In addition, the use of antiplatelet and anticoagulants that are inherently part of an AMI management may increase the risk for hemorrhagic conversion associated with intravenous thrombolysis used in AIS, and the use of a thrombolytic in AIS increases the risk of cardiac wall rupture in the setting of an AMI.Despite this ambiguity, there is no clear evidence-based guideline or clinical studies that have addressed the optimal management of this rare co-occurrence. This review paper examines the existing literature on the management of simultaneous acute cardio-cerebral infarction (CCI) and highlights the existing challenge to management.

show abstract

Incidence and Predictors of Early Left Ventricular Thrombus After ST-Elevation Myocardial Infarction in the Contemporary Era of Primary Percutaneous Coronary Intervention

Cited by 143 publications

References 27 publications

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction

Simultaneous acute cardio-cerebral infarction: is there a consensus for management?

Contact Info

Product

Resources

About