Contemporary incidence and predictors of left ventricular thrombus in patients with anterior acute myocardial infarction.

Humans Retrospective Studies Platelet Aggregation Inhibitors / therapeutic use Heart Diseases / etiology Stroke Volume Incidence Ventricular Function, Left Myocardial Infarction / complications Thrombosis / diagnosis Anterior Wall Myocardial Infarction / complications Percutaneous Coronary Intervention / adverse effects

Acute coronary syndrome Anticoagulant Antiplatelet therapy STEMI Thrombosis

Journal

Clinical research in cardiology : official journal of the German Cardiac Society

ISSN: 1861-0692

Titre abrégé: Clin Res Cardiol

Pays: Germany

ID NLM: 101264123

Informations de publication

Date de publication:
Apr 2023

Historique:

received: 06 11 2022

accepted: 10 01 2023

medline: 30 3 2023

pubmed: 19 1 2023

entrez: 18 1 2023

Statut: ppublish

Résumé

The incidence of left ventricular thrombus (LVT) after anterior acute myocardial infarction (AMI) has not been well established in the era of primary percutaneous coronary intervention (pPCI) and potent dual antiplatelet therapy. The objective of this study is to establish the contemporary incidence of LVT in this population, to identify their risk factors, and to examine their association with clinical outcomes. A multicenter retrospective cohort study including AMI patients with new-onset antero-apical wall motion abnormalities treated with pPCI between 2009 and 2017 was conducted. The primary outcome was LVT during the index hospitalization. Predictors of LVT were identified using multivariate logistic regression. Net adverse clinical events (NACE), a composite of mortality, myocardial infarction, stroke or transient ischemic attack, systemic thromboembolism or BARC type 3 or 5 bleeding at 6 months were compared between the LVT and no LVT groups. Among the 2136 patients included, 83 (3.9%) patients developed a LVT during index hospitalization. A lower left ventricular ejection fraction (LVEF) [adjusted odds ratio (aOR) 0.97; 95% confidence intervals (CI) 0.94-0.99] and the degree of worse anterior WMA (aOR 4.34; 95% CI 2.24-8.40) were independent predictors of LVT. A NACE occurred in 5 (5.72 per 100 patient-year) patients in the LVT group and in 127 (6.71 per 100 patient-year) patients in the no LVT group at 6 months [adjusted hazard ratio (aHR): 0.87; 95% CI 0.35-2.14]. The risk of LVT after anterior AMI with new-onset wall motion abnormalities is low, but this complication remains present in the contemporary era of timely pPCI and potent dual antiplatelet therapy .

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

A multicenter retrospective cohort study including AMI patients with new-onset antero-apical wall motion abnormalities treated with pPCI between 2009 and 2017 was conducted. The primary outcome was LVT during the index hospitalization. Predictors of LVT were identified using multivariate logistic regression. Net adverse clinical events (NACE), a composite of mortality, myocardial infarction, stroke or transient ischemic attack, systemic thromboembolism or BARC type 3 or 5 bleeding at 6 months were compared between the LVT and no LVT groups.

RESULTS RESULTS

Among the 2136 patients included, 83 (3.9%) patients developed a LVT during index hospitalization. A lower left ventricular ejection fraction (LVEF) [adjusted odds ratio (aOR) 0.97; 95% confidence intervals (CI) 0.94-0.99] and the degree of worse anterior WMA (aOR 4.34; 95% CI 2.24-8.40) were independent predictors of LVT. A NACE occurred in 5 (5.72 per 100 patient-year) patients in the LVT group and in 127 (6.71 per 100 patient-year) patients in the no LVT group at 6 months [adjusted hazard ratio (aHR): 0.87; 95% CI 0.35-2.14].

CONCLUSIONS CONCLUSIONS

The risk of LVT after anterior AMI with new-onset wall motion abnormalities is low, but this complication remains present in the contemporary era of timely pPCI and potent dual antiplatelet therapy .

Identifiants

DOI: 10.1007/s00392-023-02158-8 PMID: 36651998

pubmed: 36651998

doi: 10.1007/s00392-023-02158-8

pii: 10.1007/s00392-023-02158-8

doi:

Substances chimiques

Platelet Aggregation Inhibitors 0

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

558-565

Informations de copyright

Références

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