Incidence and predictors of early left ventricular thrombus after ST-elevation myocardial infarction in the contemporary era of primary percutaneous coronary intervention.
The aim of this study was to define the incidence of left ventricular thrombus (LVT) and its predictors in the contemporary era of primary percutaneous intervention (pPCI) and contrast echocardiography. We retrospectively analyzed 1,059 patients presenting with ST-elevation myocardial infarction (STEMI) to our tertiary cardiac center and treated with pPCI. Preprocedural pharmacology and procedural technique (including access route, the use of drug-eluting stents, and thrombectomy) were at the operators' discretion. Transthoracic echocardiography was performed before discharge; echo contrast agent was used when appropriate. LVT was detected in 42 subjects (4%). There were no significant differences in baseline demographics or pre-PCI clinical features between the 2 groups. Post-treatment, mean ejection fraction (EF) in patients with LVT was 35±8.4% and in those without LVT was 47±10%, p<0.001. Thirty-seven patients (88%) in the LVT group presented with an anterior STEMI versus 471 patients (42%) in the without LVT group (p<0.001). Apical akinesis was noted in all patients with LVT irrespective of the principal location of the MI. Multivariate analysis predictors of LVT were reduced EF, anterior site of MI, and the use of platelet glycoprotein IIb/IIIa inhibitors. After diagnosis of LVT, patients were treated with warfarin for 3 to 6 months. No significant difference in mortality was detectable at discharge between the 2 groups. In conclusion, in the contemporary era of pPCI, the incidence of LVT in patients with STEMI is significantly lower than that of the previous (thrombolysis) literature. The early presence of LVT is more likely in patients with anterior STEMI (involving the apex) and reduced EF.
Department of Cardiology, King's College Hospital, Denmark Hill, London, United Kingdom.
Silvia
S
Gianstefani
Department of Public Health Sciences and NIHR BRC, Guy's and St Thomas' NHS Trust, King's College London, London, United Kingdom.
Abdel
A
Douiri
Department of Cardiology, King's College Hospital, Denmark Hill, London, United Kingdom.
Ioannis
I
Delithanasis
Department of Cardiology, King's College Hospital, Denmark Hill, London, United Kingdom.
Toby
T
Rogers
Department of Cardiology, King's College Hospital, Denmark Hill, London, United Kingdom.
Arup
A
Sen
Department of Cardiology, King's College Hospital, Denmark Hill, London, United Kingdom.
Sundeep
S
Kalra
Department of Cardiology, King's College Hospital, Denmark Hill, London, United Kingdom.
Langton
L
Charangwa
Department of Cardiology, King's College Hospital, Denmark Hill, London, United Kingdom.
Joseph
J
Reiken
Department of Cardiology, King's College Hospital, Denmark Hill, London, United Kingdom.
Mark
M
Monaghan
Department of Cardiology, King's College Hospital, Denmark Hill, London, United Kingdom. Electronic address: philip.maccarthy@nhs.net.
Philip
P
MacCarthy
D017023:Coronary Angiography; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006352:Heart Ventricles; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012189:Retrospective Studies; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology