Incidence and Predictors of Left Ventricular (LV) Thrombus after ST-Elevation Myocardial Infarction (STEMI) in the Holy Capital of Saudi Arabia

Abstract

Background Patients with acute myocardial infarction (AMI) especially those with large MI (myocardial infarction) as identified by ST elevation in multiple contiguous ECG leads or anterior MI, may suffer significant myocardial damage leading to impaired wall motion and contractility which may lead to the formation of left ventricular thrombus (LVT) in the patient. This study was aimed to establish the incidence of LV thrombus and determine the predictors associated with the formation of LV thrombus in patients with AMI. Methods This retrospective study was held at the only cardiothoracic centre of Makkah, which provides tertiary level cardiac services. A total of 3084 consecutive patients with acute MI between 2016 and 2019 were identified and divided into two groups i.e. group I (with LVT) and group II (without LVT). The case notes, echocardiography data and cardiac catheterization lab records were reviewed to identify patients with LV thrombus. Regression analysis was employed to evaluate the predictors responsible for the formation of LV thrombus. Results The overall incidence for LV thrombus was determined as 8.4% (n = 260/3084), while in the subpopulation of pilgrims, it was 8.2% (83/1001). Mean age for patients with and without LVT was 54 ± 11 years vs 56 ± 12 years (p < 0.003), respectively. There was no significant difference between the two groups with respect to gender, diabetes, hypertension, smoking, Arabic speaking or BMI>30. Coronary thrombus aspiration was utilized in 17% vs 12% (p < 0.023) patients with LVT and without LVT, respectively. It was observed that the patients with cardiac arrest tend to develop more LVT i.e. 8.5% vs 5.2% (p < 0.033). However, LV thrombus formation was significantly associated with anterior STEMI with incidence of LVT reaching 13.4% and low ejection fraction (all MI types) i-e. 32 ± 9% vs 42 ± 11%, with p < 0.000 for both independent predictors. Conclusions LV thrombus is a relatively common occurrence in patients with acute MI, especially those with anterior STEMI and low ejection fraction<30%. Appropriate imaging studies are required for all acute MI patients in order to ascertain the presence or absence of LV thrombus as it has major influence on further management.

Risk factors for in-hospital systemic thromboembolism in myocardial infarction patients with left-ventricular thrombus: A multicenter retrospective study

“…Previous studies showed that LVT formation was significantly associated with lower EF. [ 13 , 24 , 25 ] However, in this investigation, HFmrEF and HFpEF were found to be independent risk factors for in-hospital ST, which indicated that the thrombus can easily be detached. In patients with HFpEF or HFmrEF, the compensatory motion of the ventricular wall in the non-infarct area is enhanced, and the contradictory motion is more prominent, which may increase the likelihood for thrombus detachment.…”

“…Previous studies have evaluated the predictors for thrombus genesis, [7][8][9] but most of the published data were obtained from case reports. [10][11][12][13][14][15][16] For example, Paolo Rubartelli et al reported that hypercoagulable state and myocardial dysfunction contributed to LVT formation in COVID-19 patients. Additionally, a recent meta-analysis showed anticoagulation and triple therapy were independent predictors of lower rates of embolic events in LVT.…”

Predictors of Left Ventricular Dysfunction after Percutaneous Primary Coronary Intervention in Acute Anterior Myocardial Infarction

“…There was highly significant difference between the groups with and without LVT as regard anterior STEMI, 94% of patients with LVT have anterior STEMI. Also, the study by Niazi et al, [14] reported that in the LVT there were 86% have anterior STEMI and in the Without LVT group 52% had anterior STEMI with high significant difference.…”

Case report: Oral anticoagulant combined with percutaneous coronary intervention for peripheral embolization of left ventricular thrombus caused by myocardial infarction in a patient with diabetes mellitus

“…The underlying endomyocardial pathological changes and low regional intracardiac blood flow velocity caused by MI are the most important mechanisms of thrombus formation ( 13 , 14 ). In most instances, a hypercoagulable state may also contribute to some extent ( 5 , 6 ).…”