Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan;42(1):69-75.
doi: 10.1002/clc.23106. Epub 2018 Nov 30.

Relationship of left ventricular thrombus formation and adverse outcomes in acute anterior myocardial infarction in patients treated with primary percutaneous coronary intervention

Qian Zhang  1 , Chun-Mei Wang  1 , Shu-Tian Shi  1 , Hong Chen  1 , Yu-Jie Zhou  2
Affiliations

Relationship of left ventricular thrombus formation and adverse outcomes in acute anterior myocardial infarction in patients treated with primary percutaneous coronary intervention

Qian Zhang et al. Clin Cardiol. 2019 Jan.

Abstract

Background: The incidence of left ventricular thrombus (LVT) is 4% to 15% in patients with anterior acute ST-segment elevation myocardial infarction (ant-AMI) in the era of primary percutaneous coronary intervention (PPCI). And patients with LVT have higher in-hospital mortality.

Hypothesis: There is a relationship between LVT formation and 1-year major adverse cardio-cerebrovascular events (MACCE) in patients with ant-AMI treated by PPCI.

Methods: Our study population included 1488 consecutive patients with ant-AMI. The primary endpoint was the incidence of MACCE within 1 year after AMI. The secondary endpoint was the thrombosis disappearance.

Results: A total of 106 (7.1%) patients were diagnosed with LVT and 1382 (92.9%) patients without LVT. Patients with LVT had a higher incidence of MACCE than in patients without LVT (21.7%vs10.3%; P < 0.001). Univariate analysis showed LVT was associated with an increase in MACCE risk (odds ratio [OR] = 2.40; 95% confidence interval [CI] [1.37-4.21]; P < 0.001). When examining MACCE components individually, LVT was only associated with the incidence of congestive heart failure (OR = 2.41; 95% CI [1.29-4.58]; P = 0.001). After adjustment for principal confounders, LVT remained an independent risk factor for MACCE (HR = 2.28; 95% CI [1.12-6.38]; P = 0.020). Other independent predictors include 24-hour LVEF, creatine kinase peak value, and age. Further analysis found patients with LVT in international normalized ratio (INR) ≥ 2 group had lower MACCE risk and higher thrombus disappearance than in INR < 2 group (13.5%vs29.6%; P = 0.044; 90.4%vs74.1%; P = 0.029).

Conclusion: For patients with ant-AMI treated by PPCI, LVT is an independent predictor of 1-year MACCE events. Treatment with vitamin K antagonist in the therapeutic range (INR ≥ 2) has the potential to reduce MACCE risk and promote disappearance of thrombus.

PubMed Disclaimer

Conflict of interest statement

The authors declare no potential conflict of interests.

Figures

Figure 1
Figure 1
Incidence of MACCE stratified according to LVT. Kaplan‐Meier analysis shows a statistically higher incidence of MACCE in patients with LVT (purple line) than those without LVT (green line) within 1 year follow‐up period (21.7% vs 10.3%). LVT, left ventricular thrombus; MACCE, major adverse cardio‐cerebrovascular events
Figure 2
Figure 2
Incidence of MACCE in patients with LVT stratified according to INR. The incidence of MACCE was significantly higher in patients with INR < 2 (purple line) than those with INR ≥ 2 (green line) within 1 year follow‐up period (29.6% vs 13.5%). INR, international normalized ratio; LVT, left ventricular thrombus; MACCE, major adverse cardio‐cerebrovascular events
See this image and copyright information in PMC

References

    1. Asinger RW, Mikell FL, Elsperger J, Hodges M. Incidence of left ventricular thrombosis after acute transmural myocardial infarction. Serial evaluation by two‐dimensional echo cardiography. N Engl J Med. 1981;305:297‐302. - PubMed
    1. Domenicucci S, Chiarella F, Bellotti P, Bellone P, Lupi G, Vecchio C. Long‐term prospective assessment of left ventricular thrombus in anterior wall acute myocardial infarction and implications for a rational approach to embolic risk. Am J Cardiol. 1999;83:519‐524. - PubMed
    1. Shacham Y, Leshem‐Rubinow E, Ben Assa E, et al. Frequency and correlates of early left ventricular thrombus formation following anterior wall acute myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol. 2013;111:667‐670. - PubMed
    1. Solheim S, Seljeflot I, Lunde K, et al. Frequency of left ventricular thrombus in patients with anterior wall acute myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy. Am J Cardiol. 2010;106:119‐1200. - PubMed
    1. Ram P, Shah M, Lo KB, Figueredo V. Reply: surprisingly low incidence of left ventricular thrombosis in anterior ST‐segment elevation myocardial infarction. Clin Cardiol. 2018. 10.1002/clc.23071. - DOI - PMC - PubMed

MeSH terms