title: Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction.
abstract: We aimed to characterize the independent predictors of LVT following STEMI and the association with outcomes. The clinical predictors of left ventricular thrombus (LVT) formation after ST-segment elevation myocardial infarction (STEMI) are not well-defined in the contemporary era. We performed a retrospective analysis of STEMI patients at Duke from 2000 to 2011 who had a transthoracic echocardiogram within 90 days post-STEMI and compared patients with and without LVT (LVT+ vs. LVT-). Univariate Cox proportional hazards regression models of baseline characteristics were examined and significant variables were used in a multivariable model to assess adjusted relationships with LVT. A multivariable Cox PH survival model with covariate adjustments was used for assessment of LVT and long-term mortality. Of all eligible patients, 1734 patients met inclusion criteria and 4.3 % (N = 74) had a LVT. LVT+ patients tended to have a history of heart failure (HF) and higher initial troponin compared to LVT- patients. After adjustment, higher heart rate, non-white race, HF severity, and presence of left anterior descending artery (LAD) disease were independent predictors of LVT. There was a trend toward an association between LVT and increased all-cause mortality (HR 1.36; 95 % CI 0.84-2.21, P = 0.22), however this was not statistically significant. LVT was seen in over 4 % of this contemporary post-STEMI population. Several baseline characteristics were independently associated with LVT: Heart rate, HF severity, LAD disease, and non-white race. Prospective studies are warranted to determine whether anticoagulation in patients at increased risk for LVT improves outcomes.
authors.affiliation: Department of Internal Medicine, Virginia Commonwealth University, 1200 East Broad St., P.O. Box 980102, Richmond, VA, 23298-0102, USA. agarber@mcvh-vcu.edu.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Garber
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Hussein R
authors.initials: HR
authors.lastname: Al-Khalidi
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Mona
authors.initials: M
authors.lastname: Fiuzat
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.|Department of Medicine, Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
mesh_terms: D000368:Aged; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D013927:Thrombosis / Q000401:mortality / Q000503:physiopathology
keywords: Anterior myocardial infarction; Heart failure; Left ventricular thrombus; Race; STEMI