title: Incidence and Predictors of Left Ventricular Thrombus After Primary Percutaneous Coronary Intervention for Anterior ST-Segment Elevation Myocardial Infarction.
abstract: BACKGROUND
  The role of warfarin in anterior ST-segment elevation myocardial infarction (STEMI) complicated by left ventricular (LV) dysfunction in patients treated with primary percutaneous coronary intervention (PCI) and dual antiplatelet therapy is unclear. Warfarin may prevent cardioembolic events but significantly increases bleeding in the setting of dual antiplatelet therapy.
  
  
  OBJECTIVE
  The incidence of LV thrombus in anterior STEMI patients treated with PCI is low, and clinical predictors might be valuable in determining patients at risk.
  
  
  METHODS
  We performed a retrospective, single-center study of 687 consecutive patients with anterior STEMI treated with PCI from 2006 to 2013. Baseline variables were evaluated in 310 patients at high risk for LV thrombus based on echocardiographic criteria. Patients with definite, probable, and no LV thrombus were compared by ANOVA, χ(2), or t test where appropriate. Logistic regression analysis was performed.
  
  
  RESULTS
  The incidence of LV thrombus was 15% (n = 47 probable/definite thrombus). Cardiac arrest was the only independent characteristic associated with increased risk of LV thrombus (odds ratio [OR]: 4.06, 95% confidence interval [CI]: 1.3-12.7). Trends were observed for a lower risk in cardiogenic shock (OR: 0.33, 95% CI: 0.10-1.05) and aspirin use at baseline (OR: 0.43, 95% CI: 0.17-1.1). Treatment variables associated with LV thrombus included unfractionated heparin use post-PCI (OR: 2.43, 95% CI: 1.16-5.1) and use of balloon angioplasty without stent.
  
  
  CONCLUSIONS
  In contemporary practice with primary PCI, definite LV thrombus following anterior STEMI with LV dysfunction is challenging to predict. Further investigation is needed to determine if there is a subset of patients that should be treated with prophylactic warfarin.
authors.affiliation: Cardiovascular Institute, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Adam
authors.initials: A
authors.lastname: Driesman
authors.affiliation: Cardiovascular Institute, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Omar
authors.initials: O
authors.lastname: Hyder
authors.affiliation: Cardiovascular Institute, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lang
authors.affiliation: Cardiovascular Institute, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Phillip
authors.initials: P
authors.lastname: Stockwell
authors.affiliation: Cardiovascular Institute, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Athena
authors.initials: A
authors.lastname: Poppas
authors.affiliation: Cardiovascular Institute, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Abbott
mesh_terms: D000368:Aged; D056988:Anterior Wall Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D000925:Anticoagulants; D006493:Heparin