Incidence of early left ventricular thrombus after acute anterior wall myocardial infarction in the primary coronary intervention era.
BACKGROUND
Rapid reperfusion has been shown to decrease mortality and improve left ventricular (LV) function. Previous studies have reported that LV thrombus (LVT) is a major complication of ST-segment elevation acute anterior wall myocardial infarction (AMI). There are little data on LVT in the current primary percutaneous coronary intervention (PPCI) era. We sought to demonstrate the incidence of LVT after AMI in patients treated with PPCI compared with those treated with thrombolysis or with conservative management.


METHODS
In a 6-year period, 642 patients with anterior wall AMI and echocardiography were treated with PPCI (n = 297), thrombolysis (n = 128), or conservative treatment (n = 217). Left ventricular thrombus was defined as an echodense mass adjacent to an abnormally contracting myocardial segment.


RESULTS
The rate of LVT among anterior wall AMI was 6.2%. Predictors for LVT were reduced ejection fraction (adjusted relative risk 0.71, 95% CI 0.52-0.96) and severe mitral regurgitation (adjusted relative risk 2.48, 95% CI 1.0-6.44). There was no statistical difference in LVT rate according to treatment: 21 (7.1%) of 297 patients in the PPCI group, 10 (7.8%) of 128 patients in the thrombolytic group, and 9 (4.1%) of 217 patients in the conservative group (P = .28). Those in the thrombolytic group were characterized by shorter duration from symptom onset and were generally also treated with heparin/low-molecular weight heparin.


CONCLUSIONS
This is the largest report to evaluate the incidence of LVT formation after AMI. In the current era of rapid reperfusion by PPCI, the rate of thrombus formation is similar to that reported in the past and not different than for patients currently treated conservatively or with thrombolysis.
Osherov
Azriel B
AB
Faculty of Medicine, Department of Cardiology, Rambam Medical Center, B. Rappaport, Technion-Israel Institute of Technology Haifa, Israel.
Borovik-Raz
Michal
M
Aronson
Doron
D
Agmon
Yoram
Y
Kapeliovich
Michael
M
Kerner
Arthur
A
Grenadier
Ehud
E
Hammerman
Haim
H
Nikolsky
Eugenia
E
Roguin
Ariel
A
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology