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

Ram, Pradhum; Shah, Mahek; Lo, Kevin Bryan; Figueredo, Vincent M.

doi:10.1002/clc.23071

Cited by 2 publications

(3 citation statements)

References 7 publications

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“…In another study, 429 ant-AMI subjects who had undergone PPCI were analyzed, results showed that 18 patients had LVT within seven days of disease onset 3 . Another study was conducted on patients with AMI treated with PPCI, results showed a 15% incidence of LVT 4 . Studies have shown that during the PCI period prevalence of LVT is significantly lowered.…”

Section: Discussionmentioning

confidence: 99%

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Association between Left Ventricular Thrombus Formation and Adverse Outcomes in Acute Anterior Myocardial Infarction Patients who had Undergone Primary Percutaneous Coronary Intervention

Hussain¹,

Kabeer²,

Shahzad³

et al. 2022

PJMHS

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Aim: To investigate the association between left ventricular thrombosis (LVT) and adverse cardio-cerebrovascular events in anterior acute ST segment elevation myocardial infarction patients who had undergone primary percutaneous coronary intervention. Study design: A retrospective study. Study place and duration: From 22nd Oct 2020 to 22nd Oct 2021 at the Cardiology department of Ch.Pervaiz Elahi Institute of Cardiology Multan. Methodology: The study included patients who were identified with anterior acute ST segment elevation myocardial infarction and received primary percutaneous intervention within the first 12 hours following onset. Patients were specifically evaluated for being treated with oral vitamin K antagonists (VKA) at discharge along with their assessment of the international normalized ratio (INR). The primary endpoint was considered as the occurrence of major cardio-cerebrovascular events, the secondary endpoint was the resolution of thrombus in LVT patients within 1 year. Results: 4(6.6%) patients were diagnosed with LVT within a month after disease onset and 56(93%) without LVT. During one year follow up, 6(10%) patients without LVT and 1(22%) patient with LVT had gone through MACCE event at least once. According to univariate analysis, LVT is related to an increase in the risk of MACCE events. The rate of heart failure differed significantly (OR = 3.42, 95% CI (1.3-4.6)). Within a year of onset, LVT was an independent predictor of MACCE (HR =2.3, 95% CI (1.11-6.40)). Moreover, in patients with INR ≥ 2 risk of MACCE was less as compared to those with INR < 2. Conclusion: LVT is an independent predictor of 1 year adverse cardio-cerebrovascular events in subjects with ant-AMI who had undergone PPCI. Within therapeutic range ≥2 treatment consists of triple therapy. It can potentially reduce the rate of MACCE events and increase the dissolution of the thrombosis. Keywords: Left venous thrombosis, anterior myocardial infarction, adverse coronary outcomes, primary cutaneous infarction,

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Section: Discussionmentioning

confidence: 99%

“…According to the studies, 40% to 60% of patients with LVT had ant-AMI 1 . Although primary percutaneous coronary intervention (PPCI) greatly helps in the reduction of infarct area and development of LVT, 4-15% of cases with ant-AMI still report thrombus formation even after receiving PPCI 2,3,4 .…”

Section: Introductionmentioning

confidence: 99%

Association between Left Ventricular Thrombus Formation and Adverse Outcomes in Acute Anterior Myocardial Infarction Patients who had Undergone Primary Percutaneous Coronary Intervention

Hussain¹,

Kabeer²,

Shahzad³

et al. 2022

PJMHS

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show abstract

“…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.…”

mentioning

confidence: 99%

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

Zhang

Wang

Shi

et al. 2018

Clinical Cardiology

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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....

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

Cited by 2 publications

References 7 publications

Association between Left Ventricular Thrombus Formation and Adverse Outcomes in Acute Anterior Myocardial Infarction Patients who had Undergone Primary Percutaneous Coronary Intervention

Association between Left Ventricular Thrombus Formation and Adverse Outcomes in Acute Anterior Myocardial Infarction Patients who had Undergone Primary Percutaneous Coronary Intervention

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

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