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

Autor: Boivin-Proulx LA; Université de Montréal, Montreal, QC, Canada.; CHUM Research Center and Cardiovascular Center, Montreal, QC, Canada., Ieroncig F; Université de Montréal, Montreal, QC, Canada.; Montreal Heart Institute, 5000 Belanger, Montreal, Qc, H1T 1C8, Canada., Demers SP; Université de Montréal, Montreal, QC, Canada.; Montreal Heart Institute, 5000 Belanger, Montreal, Qc, H1T 1C8, Canada., Nozza A; Montreal Heart Institute, 5000 Belanger, Montreal, Qc, H1T 1C8, Canada., Soltani M; Université de Montréal, Montreal, QC, Canada.; Maisonneuve-Rosemont Hospital, Montreal, QC, Canada., Ghersi I; Université de Montréal, Montreal, QC, Canada.; Montreal Heart Institute, 5000 Belanger, Montreal, Qc, H1T 1C8, Canada., Verreault-Julien L; Sherbrooke University Hospital Center, Sherbrooke, QC, Canada., Alansari Y; Division of Cardiology, Department of Medicine, Jewish General Hospital and McGill University, Montreal, QC, Canada., Massie C; Université de Montréal, Montreal, QC, Canada.; Cardiology Division, CIUSSS-NÎM, Sacré-Coeur Hospital, Montreal, QC, Canada., Simard P; Université de Montréal, Montreal, QC, Canada., Rosca L; Université de Montréal, Montreal, QC, Canada., Lalancette JS; Quebec Heart and Lung Institute, Quebec, QC, Canada., Massicotte G; Quebec Heart and Lung Institute, Quebec, QC, Canada., Chen-Tournoux A; Division of Cardiology, Department of Medicine, Jewish General Hospital and McGill University, Montreal, QC, Canada., Daneault B; Sherbrooke University Hospital Center, Sherbrooke, QC, Canada., Paradis JM; Quebec Heart and Lung Institute, Quebec, QC, Canada., Diodati JG; Université de Montréal, Montreal, QC, Canada.; Cardiology Division, CIUSSS-NÎM, Sacré-Coeur Hospital, Montreal, QC, Canada., Pranno N; Université de Montréal, Montreal, QC, Canada.; Maisonneuve-Rosemont Hospital, Montreal, QC, Canada., Jolicoeur M; Université de Montréal, Montreal, QC, Canada.; Montreal Heart Institute, 5000 Belanger, Montreal, Qc, H1T 1C8, Canada., Potter BJ; Université de Montréal, Montreal, QC, Canada.; CHUM Research Center and Cardiovascular Center, Montreal, QC, Canada., Marquis-Gravel G; Université de Montréal, Montreal, QC, Canada. guillaume.marquis.gravel@umontreal.ca.; Montreal Heart Institute, 5000 Belanger, Montreal, Qc, H1T 1C8, Canada. guillaume.marquis.gravel@umontreal.ca.
Jazyk: angličtina
Zdroj: Clinical research in cardiology : official journal of the German Cardiac Society [Clin Res Cardiol] 2023 Apr; Vol. 112 (4), pp. 558-565. Date of Electronic Publication: 2023 Jan 18.
DOI: 10.1007/s00392-023-02158-8
Abstrakt: Background: 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.
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: 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: 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 .
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
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