title: Incidence and outcomes of early left ventricular thrombus following ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.
abstract: BACKGROUND
  Since the advent of primary percutaneous coronary intervention (PCI), studies have reported a declining incidence of left ventricular thrombus (LVT) following ST-elevation myocardial infarction (STEMI). We investigated the incidence and outcomes of early (pre-discharge) LVT in the contemporary era of PCI practice in a large cohort of STEMI patients.
  
  
  METHODS
  We retrospectively studied 2071 consecutive STEMI patients who underwent successful primary PCI. Screening echocardiography was performed within 24-48 h of admission. Patients with anterior STEMI were treated with intravenous heparin for 24-48 h until a first echocardiography test was performed. Patients with reduced ejection fraction (EF) ≤40% had a repeat test before hospital discharge (days 5-7). Heparin was continued in case of significant left ventricular dysfunction (EF < 35%) or apical akinesis or dyskinesis, until a second test ruled out LVT.
  
  
  RESULTS
  LVT was diagnosed before hospital discharge in 31/2071 patients (1.5%), 28 of whom (90%) had anterior STEMI. Only 2/31 patients with LVT (6.5%) developed embolic events before discharge and 1/31 (3.2%) had an episode of upper gastrointestinal bleeding that required blood transfusion. There was no significant difference between the two groups regarding in-hospital STEMI-related complications, short- and long-term mortality. All LVTs resolved in subsequent echocardiograms within 6 months of discharge.
  
  
  CONCLUSIONS
  We report a low incidence of early LVT following STEMI. Further studies are needed to assess the efficacy and safety of a limited in-hospital anticoagulation protocol in STEMI patients with reduced EF.
authors.affiliation: The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Shafik.khoury@gmail.com.|Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Shafik.khoury@gmail.com.
authors.forename: Shafik
authors.initials: S
authors.lastname: Khoury
authors.affiliation: The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Sarit
authors.initials: S
authors.lastname: Carmon
authors.affiliation: The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Gilad
authors.initials: G
authors.lastname: Margolis
authors.affiliation: The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.affiliation: The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Yacov
authors.initials: Y
authors.lastname: Shacham
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D004452:Echocardiography / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000628:therapy*; D013927:Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Anticoagulation following STEMI; Left ventricular thrombus; Primary percutaneous coronary intervention; ST-elevation myocardial infarction