Relationship of left ventricular thrombus formation and adverse outcomes in acute anterior myocardial infarction in patients treated with primary percutaneous coronary intervention

Abstract

Background: The incidence of left ventricular thrombus (LVT) is 4% to 15% in patients with anterior acute ST-segment elevation myocardial infarction (ant-AMI) in the era of primary percutaneous coronary intervention (PPCI). And patients with LVT have higher in-hospital mortality.Hypothesis: There is a relationship between LVT formation and 1-year major adverse cardiocerebrovascular events (MACCE) in patients with ant-AMI treated by PPCI. Methods:Our study population included 1488 consecutive patients with ant-AMI. The primary endpoint was the incidence of MACCE within 1 year after AMI. The secondary endpoint was the thrombosis disappearance.Results: A total of 106 (7.1%) patients were diagnosed with LVT and 1382 (92.9%) patients without LVT. Patients with LVT had a higher incidence of MACCE than in patients without LVT (21.7%vs10.3%; P < 0.001). Univariate analysis showed LVT was associated with an increase in MACCE risk (odds ratio [OR] = 2.40; 95% confidence interval ; P < 0.001).When examining MACCE components individually, LVT was only associated with the incidence of congestive heart failure (OR = 2.41; 95% CI [1.29-4.58]; P = 0.001). After adjustment for principal confounders, LVT remained an independent risk factor for MACCE (HR = 2.28; 95% CI [1.12-6.38]; P = 0.020). Other independent predictors include 24-hour LVEF, creatine kinase peak value, and age. Further analysis found patients with LVT in international normalized ratio (INR) ≥ 2 group had lower MACCE risk and higher thrombus disappearance than in INR < 2 group (13.5%vs29.6%; P = 0.044; 90.4%vs74.1%; P = 0.029). Conclusion:For patients with ant-AMI treated by PPCI, LVT is an independent predictor of 1-year MACCE events. Treatment with vitamin K antagonist in the therapeutic range (INR ≥ 2) has the potential to reduce MACCE risk and promote disappearance of thrombus. | INTRODUCTIONLeft ventricular thrombosis (LVT) is a common complication of anterior acute ST-segment elevation myocardial infarction (ant-AMI). In the early 1990s, 40% to 60% of patients with ant-AMI were found to be accompanied by LVT. 1,2 The development of primary percutaneous coronary intervention (PPCI) greatly reduced the infarct area and the formation of LVT. Despite progress made in decreasing formation of LVT, reports indicate thrombosis formation is between 4% and 15% in patients with ant-AMI after treatment with PPCI. [3][4][5] At present, the molecular mechanisms of LVT are unclear. Generally, LVT is believed to be associated with abnormal blood flow stagnation, injury to the endocardium, inflammatory cascade, and high coagulation state during myocardial infarction. Regardless of the treatment of myocardial infarction, risk factors for LVT usually include large infarct area, severe ventricular wall in coordination, and anterior wall myocardial infarction .1,4,6-8 Patients with ant-AMI are five times more likely to develop LVT than those with other types of ant-AMI.Furthermore, the incidence of LVT in patients with LVEF < 40% is higher than in patients with normal LVEF (10....

In-hospital left ventricular thrombus following ST-elevation myocardial infarction

“…Left ventricular (LV) thrombus following ST-elevation myocardial infarction (STEMI) carries significant risk for catastrophic complications including stroke and death. [1][2][3][4][5] It may also increase resources utilization, length of hospital stay and overall health care burden. The general characteristics of STEMI patients who are at increased risk for developing LV thrombus has been reported in small studies.…”

Prognosis and New Predictors of Early Left-Ventricular Thrombus Following ST-Elevation Myocardial Infarction

“…It is well established that heart failure is a strong predictor of LVT in STEMI patients. 31,32 Inversely, LVT might be an important trigger of heart failure. In the prethrombolytic period, LVT was associated with a 5.5-fold increase in embolic events.…”

Frequency of Left Ventricular Thrombus after Acute Anterior Wall Myocardial Infarction at Karachi

“…Up to 60% of patients with severe anterior wall myocardial infarctions were found to have LV thrombi in the thrombolytic era 6 . The systemic thrombolysis reduces the development of LV thrombus, even though this condition is frequently seen in individuals with severe anterior wall myocardial infarctions 7 . Up to 20% of AMI patients have been documented to have LV thrombi that have been embolized 8 .…”