Left Ventricular Thrombus in Myocardial Infarction After Successful Primary Percutaneous Coronary Intervention: Prevalence and Predictors—A Middle Eastern Single-Centre Experience

• Published in: CJC open (Online) 2020-05, Vol.2 (3), p.104-110
• Main Authors: Khaled, Sheeren, Hachicha, Zeineb, Elkhateeb, Osama
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2589-790X; 2589-790X
• DOI: 10.1016/j.cjco.2020.02.001

Left ventricular thrombus (LVT) is a well-recognized complication of myocardial infarction that affects patient outcomes and warrants screening. This retrospective study included 308 consecutive patients who presented with acute ST-elevation myocardial infarction and were treated with primary percutaneous coronary intervention. Early screening for LVT by echocardiography and cardiac magnetic resonance revealed the following: LVT (+) group (36 patients [11.7%]) and LVT (−) group (272 patients [88.3%]). The 2 powerful independent variables associated with LVT formation were left anterior descending–related infarct (odds ratio, 10.17; P < 0.0001) and severe left ventricular systolic dysfunction (odds ratio, 8.3; P = 0.0001). The lower the left ventricular ejection fraction, the higher the risk of LVT was. Multivessel coronary artery disease and the type of early invasive strategy (culprit lesion only vs complete revascularization) were not predictive of LVT. The impact of environment (i.e., hot climate, exercise) and dehydration on the risk of LVT formation is uncertain. Early LVT formation is a frequent complication in acute ST-elevation myocardial infarction despite timely intervention. Its independent predictors are left anterior descending–related infarct and severe left ventricular systolic dysfunction. In patients with multivessel coronary artery disease, there was no significant difference between lesion-only culprits and complete revascularization in reducing the risk of LVT development. Further studies in larger numbers of patients are needed because of the uncertainties regarding the links between the biological effects of the environment and the risk of LVT formation. La thrombose du ventricule gauche (TVG) est une complication notoire de l’infarctus du myocarde qui influe sur l’évolution de l’état de santé du patient et nécessite un dépistage. Cette étude rétrospective inclu 308 patients consécutifs ayant subi un infarctus aigu du myocarde avec élévation du segment ST et traité par une angioplastie coronaire percutanée primaire. Le dépistage précoce de la TVG par échocardiographie et résonance magnétique cardiaque a révélé que 36 patients (11,7 %) présentaient une TVG, et 272 patients (88,3 %) n’en présentaient pas. Les deux variables indépendantes fortement associées à la TVG étaient l’infarctus dans le territoire de l’artère interventriculaire antérieure (rapport de cotes : 10,17; p < 0,0001) et une sévère dysfonction systolique ventriculaire ga