Left Ventricular Thrombus Formation After ST-Segment-Elevation Myocardial Infarction: Insights From a Cardiac Magnetic Resonance Multicenter Study.
BACKGROUND
Data on left ventricular (LV) thrombus formation after primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction (STEMI) are scarce. The aims of this study were to assess the (1) incidence of LV thrombi using cardiac magnetic resonance in a multicenter cohort of STEMI patients and (2) prognostic relevance of LV thrombi at 1-year follow-up.


RESULTS
In total, 738 STEMI patients reperfused by primary angioplasty were enrolled in 8 centers. Cardiac magnetic resonance was completed within 1 week after infarction. Central core laboratory-masked analyses for the presence of LV thrombi were performed. The primary clinical end point was the occurrence of major adverse cardiac events within 1 year. LV thrombi were detected in 26 patients (3.5%) in the overall cohort and in 7.1% in anterior STEMI patients. The presence of thrombi was associated with larger infarcts (P<0.001), less myocardial salvage (P<0.01), impaired LV ejection fraction (P<0.001), and more pronounced late microvascular obstruction (P=0.002). The presence of thrombi was independently associated with the incidence of major adverse cardiac events at 12 months (hazard ratio, 2.73; 95% confidence interval, 1.11-6.73; P=0.03).


CONCLUSIONS
In this multicenter cohort of patients with STEMI, thrombus prevalence assessed by cardiac magnetic resonance was 3.5% and associated with decreased myocardial salvage, larger infarcts, and more pronounced reperfusion injury. Importantly, LV thrombus was independently associated with major adverse cardiac events at 1-year follow-up.


BACKGROUND
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00712101.
From the Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, Luebeck, Germany.
Janine
J
Pöss
From the Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, Luebeck, Germany.
Steffen
S
Desch
From the Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, Luebeck, Germany.
Charlotte
C
Eitel
From the Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, Luebeck, Germany.
Suzanne
S
de Waha
From the Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, Luebeck, Germany.
Holger
H
Thiele
From the Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, Luebeck, Germany. ingoeitel@gmx.de.
Ingo
I
Eitel
D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage; D007269:Injections, Intra-Arterial; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011379:Prognosis; D011446:Prospective Studies; D013927:Thrombosis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D016277:Ventricular Function, Left
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab
incidence; myocardial infarction; percutaneous coronary intervention; prevalence; prognosis