Left Ventricular Thrombus After Primary PCI for ST-Elevation Myocardial Infarction: 1-Year Clinical Outcomes.
Aged
Anticoagulants
/ therapeutic use
Chi-Square Distribution
Echocardiography
/ methods
Electrocardiography
/ methods
Female
Humans
Logistic Models
Male
Middle Aged
Percutaneous Coronary Intervention
/ methods
ST Elevation Myocardial Infarction
/ physiopathology
Thrombosis
/ complications
Treatment Outcome
Anticoagulation
Clinical outcomes
Left ventricular thrombus
ST elevation myocardial infarction (STEMI)
Journal
The American journal of medicine
ISSN: 1555-7162
Titre abrégé: Am J Med
Pays: United States
ID NLM: 0267200
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
20
02
2019
revised:
20
02
2019
accepted:
21
02
2019
pubmed:
16
3
2019
medline:
30
1
2020
entrez:
16
3
2019
Statut:
ppublish
Résumé
Left ventricular thrombus formation is a complication of acute myocardial infarction. However, the incidence and risk of systemic thromboembolism in the era of primary angioplasty for ST elevation myocardial infarction (STEMI) is unclear. This study aims to determine clinical outcomes in patients with STEMI treated with primary angioplasty and left ventricular thrombus at 1 year. Patients who underwent primary angioplasty for STEMI and had a transthoracic echocardiogram were recruited. The primary endpoint was a composite of all-cause mortality, stroke, and systemic thromboembolism at 1 year. For the primary endpoint, the difference between the presence and absence of left ventricular thrombus was compared using a logistic regression, adjusting for minimization variables including age, diabetes mellitus, hypertension, and previous stroke. Of 2608 patients who underwent primary angioplasty for STEMI, 1645 (63%) patients had a transthoracic echocardiogram performed during the index hospital admission. Forty patients (2.4%) had evidence of left ventricular thrombus on transthoracic echocardiography. Patients with left ventricular thrombus were more likely to develop atrial fibrillation in the immediate postinfarction period (6 [15%] vs 87 [5.4%], P = 0.025). At 1 year, the primary endpoint occurred in 4 (10%) patients with left ventricular thrombus and 146 (9.1%) who did not (logistic regression hazard ratio 0.79, 95% confidence interval 0.23-2.70). In the contemporary era of mechanical reperfusion for STEMI, echocardiographic detection of left ventricular thrombus was observed in <3% patients. The presence of left ventricular thrombus was not associated with an increased risk of systemic thromboembolism.
Sections du résumé
BACKGROUND
Left ventricular thrombus formation is a complication of acute myocardial infarction. However, the incidence and risk of systemic thromboembolism in the era of primary angioplasty for ST elevation myocardial infarction (STEMI) is unclear. This study aims to determine clinical outcomes in patients with STEMI treated with primary angioplasty and left ventricular thrombus at 1 year.
METHODS
Patients who underwent primary angioplasty for STEMI and had a transthoracic echocardiogram were recruited. The primary endpoint was a composite of all-cause mortality, stroke, and systemic thromboembolism at 1 year. For the primary endpoint, the difference between the presence and absence of left ventricular thrombus was compared using a logistic regression, adjusting for minimization variables including age, diabetes mellitus, hypertension, and previous stroke.
RESULTS
Of 2608 patients who underwent primary angioplasty for STEMI, 1645 (63%) patients had a transthoracic echocardiogram performed during the index hospital admission. Forty patients (2.4%) had evidence of left ventricular thrombus on transthoracic echocardiography. Patients with left ventricular thrombus were more likely to develop atrial fibrillation in the immediate postinfarction period (6 [15%] vs 87 [5.4%], P = 0.025). At 1 year, the primary endpoint occurred in 4 (10%) patients with left ventricular thrombus and 146 (9.1%) who did not (logistic regression hazard ratio 0.79, 95% confidence interval 0.23-2.70).
CONCLUSIONS
In the contemporary era of mechanical reperfusion for STEMI, echocardiographic detection of left ventricular thrombus was observed in <3% patients. The presence of left ventricular thrombus was not associated with an increased risk of systemic thromboembolism.
Identifiants
pubmed: 30871923
pii: S0002-9343(19)30228-1
doi: 10.1016/j.amjmed.2019.02.033
pii:
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
964-969Subventions
Organisme : Wellcome Trust
ID : WT103782AIA
Pays : United Kingdom
Organisme : British Heart Foundation
ID : FS/19/17/34172
Pays : United Kingdom
Organisme : Chief Scientific Office
ID : CGA/17/53
Pays : International
Organisme : British Heart Foundation
ID : CH/09/002
Pays : United Kingdom
Organisme : British Heart Foundation
ID : RE/13/3/30183
Pays : United Kingdom
Organisme : British Heart Foundation
ID : CH/09/002/26360
Pays : United Kingdom
Informations de copyright
Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.