Left ventricular mural thrombus after anterior ST-segment-elevation acute myocardial infarction in the era of aggressive reperfusion therapy--still a frequent complication.
BACKGROUND
Left ventricular mural thrombus (LVMT) is a well-known complication of anterior ST-elevation acute myocardial infraction (AMI). It remains unknown how modern therapies have impacted on its occurrence.


OBJECTIVE
To define the frequency of LVMT among contemporary patients with anterior ST-elevation AMI, the clinical and echocardiographic predictors of LVMT formation, and the intermediate-term outcomes of patients with LVMT.


METHODS
We retrospectively analysed patients (in the years 1997-2002) with a diagnosis of anterior ST-elevation AMI and no prior AMI, and who underwent a thorough echocardiographic assessment within 72 h of admission. Stepwise logistic regression analysis was used to define predictors of LVMT formation. Survival was calculated by the Kaplan-Meier product-limit method.


RESULTS
Of the 153 patients with complete data, LVMT was detected in 36 (23.5%). There were no significant differences in baseline demographic and clinical variables between LVMT and non-LVMT patients, or in treatments (all patients received reperfusion treatment). The mean wall motion score index was higher in LVMT than non-LVMT patients (0.88+/-1.79 versus 0.65+/-0.36, respectively; P=0.01), indicating worse cardiac systolic function. LVMT patients were treated with warfarin for 3-6 months. The incidence of death was similar between the groups (11.1% for LVMT patients versus 12.8% for non-LVMT patients, P=0.79) over a mean follow-up of 71-72 months. The only independent predictor found for LVMT occurrence was worse regional wall motion of the apex (odds ratio, 2.04, 95% confidence interval, 1.39-3.03; P<0.001).


CONCLUSIONS
In the contemporary 'real-world scenario', despite aggressive reperfusion treatment and anti-aggregant use, the incidence of LVMT remained high after anterior ST-elevation AMI. LVMT was not related to increased intermediate-term mortality when patients were treated with warfarin, and the only predictor of LVMT occurrence was regional function of the apex.
Department of Cardiology, Rabin Medical Centre and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Avital
A
Porter
Hadas
H
Kandalker
Zaza
Z
Iakobishvili
Alexander
A
Sagie
Shula
S
Imbar
Alexander
A
Battler
David
D
Hasdai
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D017023:Coronary Angiography; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D012107:Research Design; D012189:Retrospective Studies; D016019:Survival Analysis; D013927:Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors