Prognosis and New Predictors of Early Left-Ventricular Thrombus Following ST-Elevation Myocardial Infarction

Qian Zhang; Zhongfan Zhang; Lina Jin; Chengbing Wang; Haikuo Zheng; Shouping Li; Miao Yu; Daoyuan Si; Wenqi Zhang

doi:10.2147/IJGM.S343418

Prognosis and New Predictors of Early Left-Ventricular Thrombus Following ST-Elevation Myocardial Infarction

Int J Gen Med. 2021 Nov 30:14:8991-9000. doi: 10.2147/IJGM.S343418. eCollection 2021.

Authors

Qian Zhang¹, Zhongfan Zhang¹, Lina Jin², Chengbing Wang³, Haikuo Zheng¹, Shouping Li¹, Miao Yu¹, Daoyuan Si¹, Wenqi Zhang¹

Affiliations

¹ Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, People's Republic of China.
² Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, People's Republic of China.
³ Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, People's Republic of China.

Abstract

Objective: In the current era of primary percutaneous coronary intervention (PPCI), the prognosis of the left ventricular thrombus (LVT) is not well assessed.

Methods: We performed a retrospective, single-center study of 1305 consecutive ST-segment-elevation myocardial infarction (STEMI) patients treated with PPCI. During a mean period of 27 months of follow-up, the major adverse cardiovascular and cerebrovascular events (MACCE) were recorded.

Results: The incidence of LVT (n = 47) was 3.60%. The independent risk factors of LVT included anterior STEMI, left ventricular (LV) aneurysm, reduced LV ejection fraction (LVEF), dilated LV end-diastolic dimension (LVEDD), and delayed door-to-balloon time (DTBT). During follow-up, LVT was an independent risk factor for MACCE [hazard ratio (HR)=3.46; 95% confidence interval (CI) = 2.23-3.38; P < 0.01]. Patients with LVT were more likely to have the following complications: heart failure (P < 0.001), embolic events (P = 0.034), and all-cause mortality (P = 0.020). Notably, the regression of LVT was not independently associated with those three adverse events (P > 0.05).

Conclusion: In the era of PPCI, the presence of early LVT following STEMI was associated with adverse events. Furthermore, the prognosis of patients with LVT did not improve even if the LVT regressed. LVT was likely a generalized indicator of impaired cardiac performance, rather than the cause. This indicated that prophylactic therapy and identifying individuals with a high risk of developing LVT were of substantial importance.

Keywords: ST-segment elevation myocardial infarction; left ventricular thrombus; prognosis; risk factors.

Grants and funding

This work was supported by grants from the Scientific and Technological Developing Scheme of Ji Lin Province (20210204199YY) and Science and Technology of Jilin Province (20180520054JH and 20200801076GH).