Atrial fibrillation, intra-ventricular thrombus, and other anticoagulant indications relationship with adverse outcomes in acute anterior myocardial infarction patients

Abstract

Background: The aim of this study was to assess the predictive value of atrial fibrillation (AF), left ventricular thrombus (LVT), and other oral anticoagulant (OAC) indications on 1-year major adverse cardio-cerebrovascular events (MACCE) and bleeding in acute anterior ST-elevated myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI).

Methods: Our study population included 969 anterior STEMI patients referred for PPCI from the prospective multicenter CIRCUS trial. Patients with a formal indication of OAC within the first year were compared to those without indication.

Results: A total of 161 (16.6%) patients were eligible for OAC after anterior STEMI mainly for AF (51.5%) and LVT (39.7%). This group had a higher morbidity profile despite similar reperfusion settings - 67% of them were treated with OAC. At 1 year, OAC indication was associated with a significant increase in MACCE rate [OR 3.37 95% CI (2.36;4.82) p<0.001] as well as bleeding [OR=1.96 95% CI (1.09;3.50) p=0.02]. After adjustment for principal confounders, OAC indication remained strongly associated with MACCE [HR 3.40 (1.26;9.14) p=0.016].

Conclusions: In a prospective cohort of anterior STEMI, AF, LVT, and other OAC indications were present upon discharge in 1 patient out of 6 and only two thirds were treated with OAC. OAC indication was independently associated with an increased risk of MACCE and bleeding at one year.

Keywords: Anterior myocardial infarction; Atrial arrhythmia; Heart failure; Left ventricular thrombus.