Left ventricular thrombosis in acute anterior myocardial infarction: Evaluation of hospital mortality, thromboembolism, and bleeding

Ram, Pradhum; Shah, Mahek; Sirinvaravong, Natee; Lo, Kevin Bryan; Patil, Shivaraj; Patel, Brijesh; Tripathi, Byomesh; Garg, Lohit; Figueredo, Vincent M.

doi:10.1002/clc.23039

Cited by 30 publications

(20 citation statements)

References 32 publications

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“…NIS is the largest database of hospital inpatient stays in the United States (US), generated by the Agency for Healthcare Research and Quality (AHRQ). This database accounts for approximately up to 8 million discharges each year; and has been used in the past for ascertainment, tracking, and assessment of national trends in health care provision, access, major procedures related outcomes, disparity of care, hospitalizations rates, and analysis of health care economics and quality control measures . Each individual hospitalization in NIS is deidentified and kept as a unique entry with one primary discharge diagnosis and < 29 secondary diagnoses during that hospitalization.…”

Section: Methodsmentioning

confidence: 99%

Burden and trends of arrhythmias in hypertrophic cardiomyopathy and its impact of mortality and resource utilization

Tripathi

Khan

Arora

et al. 2019

Journal of Arrhythmia

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Background Hypertrophic cardiomyopathy (HCM) accounts for significant morbidity and mortality worldwide. Arrhythmias are considered the main cause of mortality, however, there is paucity of data relating to trends of arrhythmia and associated outcomes in HCM patients. Methods Nationwide Inpatient Sample from 2003 to 2014 was analyzed. HCM related hospitalizations were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9‐CM) code 425.1 and 425.11 in all diagnosis fields. Results Overall, there was an increase in number of hospitalizations related to arrhythmias among HCM patients from 7784 in 2003 to 8380 in 2014 (relative increase 10.5%, P < 0.001). The increase was most significant in patients ≥ 80 years and those with higher comorbidity burden. Atrial fibrillation (AF) was the most frequently occurring arrhythmia however atrial flutter (AFL) witnessed the highest rise during the study period. In general, there was a down trend in mortality with the greatest reduction occurring in patients with ventricular fibrillation/flutter (VF/VFL). The mean length of stay was higher if patients had arrhythmia, which led to increased cost of care from $16105 in 2003 to $19310 in 2014 (relative increase 22.9%, P < 0.001). Conclusion There is overall decline in HCM related hospitalizations but rise in hospitalization among HCM patients with arrhythmias. HCM with arrhythmia accounts for significant inpatient mortality coupled with prolonged hospital stay and increased cost of care. However, there is an encouraging downtrend in the mortality most likely because of improved clinical practice, cardiac screening and primary and secondary prevention strategies.

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Section: Methodsmentioning

confidence: 99%

Burden and trends of arrhythmias in hypertrophic cardiomyopathy and its impact of mortality and resource utilization

Tripathi

Khan

Arora

et al. 2019

Journal of Arrhythmia

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“…В большинстве случаев при переднем ИМ инфаркт-связанной является передняя межжелудочковая артерия, на зону кровоснабжения которой приходится от 45 до 55 % миокарда левого желудочка (ЛЖ). При передней локализации ИМ часто возникают такие осложнения, как формирование аневризмы и образование тромба в ЛЖ [23].…”

Section: Discussionunclassified

The risk score for in-hospital mortality in patients with ST-segment elevation myocardial infarction

et al. 2021

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Aim To develop a scale (score system) for predicting the individual risk of in-hospital death in patients with ST segment elevation acute myocardial infarction (STEMI) with an account of results of percutaneous coronary intervention (PCI).Material and methods The analysis used data of 1 649 sequential patients with STEMI included into the hospital registry of PCI from 2006 through 2017. To test the model predictability, the original sample was divided into two groups: a training group consisting of 1150 (70 %) patients and a test group consisting of 499 (30 %) patients. The training sample was used for computing an individual score. To this purpose, β-coefficients of each variable obtained at the last stage of the multivariate logistic regression model were subjected to linear transformation. The scale was verified using the test sample.Results Seven independent predictors of in-hospital death were determined: age ≥65 years, acute heart failure (Killip class III-IV), total myocardial ischemia time ≥180 min, anterior localization of myocardial infarction, failure of PCI, SYNTAX scale score ≥16, glycemia on admission ≥7.78 mmol/l for patients without a history of diabetes mellitus and ≥14.35 mmol/l for patients with a history of diabetes mellitus. The contribution of each value to the risk of in-hospital death was ranked from 0 to 7. A threshold total score of 10 was determined; a score ≥10 corresponded to a high probability of in-hospital death (18.2 %). In the training sample, the sensitivity was 81 %, the specificity was 80.6 %, and the area under the curve (AUC) was 0.902. In the test sample, the sensitivity was 96.2 %, the specificity was 83.3 %, and the AUC was 0.924.Conclusion The developed scale has a good predictive accuracy in identifying patients with acute STEMI who have a high risk of fatal outcome at the hospital stage.

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“…We read with great interest the study by Ram et al They concluded in their study that patients with left ventricular thrombus (LVT) postanterior ST-segment elevation myocardial infarction (STEMI) was associated with increased in-hospital thromboembolic events and length of hospital stay, but not in-hospital mortality or bleeding risks compared to those without LVT formation. 1 They also reported a low incidence of LVT in anterior STEMI, which is of interest given the considerable sample size. However, we are concerned if this may limit the generalizability of the results.…”

Section: Surprisingly Low Incidence Of Left Ventricular Thrombosis Inmentioning

confidence: 90%

Surprisingly low incidence of left ventricular thrombosis in anterior ST‐segment elevation myocardial infarction

Leow

Sia

Tan

et al. 2018

Clinical Cardiology

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We read with great interest the study by Ram et al. They concluded in their study that patients with left ventricular thrombus (LVT) postanterior ST-segment elevation myocardial infarction (STEMI) was associated with increased in-hospital thromboembolic events and length of hospital stay, but not in-hospital mortality or bleeding risks compared to those without LVT formation. 1 They also reported a low incidence of LVT in anterior STEMI, which is of interest given the considerable sample size. However, we are concerned if this may limit the generalizability of the results.In that study, presence of cardiac thrombosis (CAT) was identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD9-CM) diagnosis code 429.79, which was then equated to LVT formation. However, we are unsure if this coding is likely to be representative of all anterior STEMI patients with LVT formation, as the exceedingly low incidence of LVT (0.4%, n = 649) was a surprising finding when compared to contemporary studies. For example, Shacham et al 2 reported an incidence of 4.0% (n = 18) in a similar population of post-anterior STEMI patients, while an analysis of our center's STEMI registry revealed an incidence of 3.0% (n = 120) for presence of LVT. Given that anterior STEMI is a known risk factor of LVT formation, 3 one would also expect its incidence to be much higher in this study. Lastly, CAT could be due to various forms of intra-cardiac thrombus besides LVT 4 such as left atrial thrombus or left atrial appendage thrombus, hence may not be entirely valid to equate them to LVT.The study draws its conclusion based on an analysis of data over a relatively long period from 2002 to 2014, hence we wonder if there might be significant heterogeneity present. Over the years, improvements in revascularization techniques, fast accessibility to primary percutaneous coronary intervention and advent of newer generation drug-eluting stents have been reported to improve rates of LV thrombus formation in post-STEMI patients. 5,6 Perhaps it may be interesting to compare the incidence and corresponding outcomes of STEMI patients with and without LVT across different eras of revascularization techniques. CONFLICTS OF INTERESTThe authors declare no potential conflict of interests. ORCIDAloysius Sheng-Ting Leow

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Left ventricular thrombosis in acute anterior myocardial infarction: Evaluation of hospital mortality, thromboembolism, and bleeding

Abstract: Among patients hospitalized with anterior STEMI, presence of LVT is associated with increased thromboembolic events, average length of hospital stay and average cost of hospitalization. However, it is not associated with increased in-hospital mortality or bleeding events.

Cited by 30 publications

References 32 publications

Burden and trends of arrhythmias in hypertrophic cardiomyopathy and its impact of mortality and resource utilization

Burden and trends of arrhythmias in hypertrophic cardiomyopathy and its impact of mortality and resource utilization

The risk score for in-hospital mortality in patients with ST-segment elevation myocardial infarction

Surprisingly low incidence of left ventricular thrombosis in anterior ST‐segment elevation myocardial infarction

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