ISSN 2996-8215
International Journal of Cardiology | Vol. 16, No. 1, January 2025 | pp. 1–8
DOI: 10.46882/2025/IJC/000189
Original Research Article
Incidence and Structural Predictors of Left Ventricular Thrombus after STEMI in the Primary Reperfusion Era Using Contrast CMR
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 formation is a severe complication of ST-segment elevation myocardial infarction (STEMI) that poses a substantial systemic thromboembolic risk. While primary percutaneous coronary intervention (PPCI) limits overall infarct size, the modern incidence and specific predictors of LV thrombus remain poorly characterized in real-world clinical cohorts. This prospective observational study sought to determine the incidence and structural predictors of LV thrombus after STEMI in the current mechanical reperfusion era using delayed-enhancement cardiac magnetic resonance (CMR) imaging. We evaluated 210 consecutive patients successfully treated with timely PPCI for an acute first STEMI. All patients underwent comprehensive contrast-enhanced CMR imaging at a median of 5 days post-infarction. LV thrombus was identified in 16 patients (7.6%). On univariate analysis, thrombus formation was strongly associated with an 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, total mass of late gadolinium enhancement significantly increased thrombus probability (odds ratio: 1.45 per 10g increase, p < 0.01). Despite prompt mechanical revascularization with PPCI, left ventricular thrombus forms in 7.6% of acute STEMI cases, concentrated primarily among patients presenting with anterior wall infarctions and severely depressed systolic function.
Keywords: ST-segment elevation myocardial infarction, Primary percutaneous coronary intervention, Left ventricular thrombus, Cardiac magnetic resonance, Ejection fraction, Microvascular obstruction
Received: October 12, 2024; Revised: November 25, 2024; Accepted: December 15, 2024; Published: January 22, 2025