ISSN 2996-8215
International Journal of Cardiology | Vol. 3, No. 1, January 2012 | pp. 1–8
DOI: 10.46882/2012/IJC/000034
Original Research Article
Incidence and Predictors of Left Ventricular Thrombus Formation After ST-Segment Elevation Myocardial Infarction in the Primary PCI Era
Robert J. Davies¹, Edward M. Walsh¹, Simon T. Green²
¹Cardiovascular Research Center, Trinity College Dublin, Dublin, Ireland
²Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom
Abstract:
Left ventricular (LV) thrombus is a recognized complication of ST-segment elevation myocardial infarction (STEMI) that poses a substantial systemic embolic risk. While primary percutaneous coronary intervention (PPCI) limits infarct size, the modern incidence and specific predictors of LV thrombus formation remain poorly defined. This prospective observational study sought to determine the incidence and predictors of LV thrombus after STEMI in the current PPCI era using delayed-enhancement cardiac magnetic resonance (CMR) imaging. We evaluated 210 consecutive patients successfully treated with PPCI for an acute first STEMI. All patients underwent CMR imaging at a median of 5 days post-infarction. LV thrombus was identified in 16 patients (7.6%). On univariate analysis, LV thrombus was strongly associated with anterior MI location, lower left ventricular ejection fraction (LVEF), and larger microvascular obstruction (MVO) zones. Multivariable logistic regression revealed that an anterior STEMI location (odds ratio: 4.12, 95% CI: 1.54–11.02, p = 0.005) and a baseline CMR-derived LVEF less than 40% (odds ratio: 3.24, 95% CI: 1.21–8.68, p = 0.02) were independent predictors of thrombus formation. Furthermore, the total mass of late gadolinium enhancement (per 10g increase) significantly increased thrombus probability (odds ratio: 1.45, p < 0.01). Despite prompt mechanical reperfusion with PPCI, left ventricular thrombus forms in 7.6% of acute STEMI cases. Patients presenting with anterior myocardial infarction and severely depressed systolic function exhibit the highest risk and may benefit from targeted screening.
Keywords: ST-segment elevation myocardial infarction, Primary percutaneous coronary intervention, Left ventricular thrombus, Cardiac magnetic resonance, Ejection fraction
Received: October 12, 2011; Revised: November 25, 2011; Accepted: December 15, 2011; Published: January 22, 2012
Citation: International Journal of Cardiology, 2012, Vol. 3, No. 1, pp. 1–8, DOI: 10.46882/2012/IJC/000034